Amyl Nitrosum

Authorities. 12, Dr. Kelp, Deutsche Archiv fur Khu. Med., 1875, vol. XV, p. 602, effects of inhaling 5 drops on cotton, in a case of melancholia ; 13, Dr. Ang. Ladendorf, Berliner Khu. Woch., No. 43 (Loud. Med. Rec., vol. iii, 1875, p. 18) ; (14 to 26, C. Wesselhoeft, M.D., New Eug. Med. Gaz., vol. xi, p. 388) ; 14, C. E. H., M.D., proving by inhalation ; 15, Mr. L. A. P., same ; 16, Mr. W. R. B., inhaled 1st dec. dil. three times at intervals of five minutes; 17, Miss M. M., proving by inhalation; 18, Miss A. E. S., same; 19, Mr. E. B. H., took internally 2d cent, dil., took 1 drop, and alter thirty minutes 3 drops, after another thirty minnies 3 drops again, the next day 10 drops, after an hour 20 drops, the next morning 40 drops; 20, Mr. H. E. R., took 24 cent, at 1.15, 3,’and 3.30 P.M., 2 drops at 4 p.m., diluted medicine and took 3 drops at 4.30 P.M., 4 drops at 5 p.m. ; 21, Miss A. W. S., took 1 drop 2d cent, at 1.30 and 3 P.M., 2 drops at 5 and 9 p.m. ; 21 a, same, two days later, took 5 drops at 3 and 7.45 p.m.; 216, same, five days later, took 10 drops; 21c, same, effects of inhalation ; 22, Mr. L. A. P., took 3 drops of 2d cent, at 7, 8, and 10 P.M. (first day), same at 9 a.m. (second day) ; 23, L. G. H. R.,. took 2 drops of 2d cent, in half a spoonful of water, at 1.45 p.m., and at 3.17 P.M.; 24, Mr. H. P. C., took 1 drop at 3.30 p.m., 3 at 5 p.m., 6 at 7.30 and 9.30 p.m. (first day), 10 at 10 a.m. (second day), 15 at 4 p.m., 20 at 4.30 P.M., 40 at 5.15 p.m. (sixth day); 25, Miss A. PI S., took 3 drops 2d cent, in about three tablespoonfuls of water, a spoonful at 7, 7.15, and 7.30 A.M., put 12 drops in half a glass of water, and took 2 teaspoonfuls at 2.30, 2.45, and 3 p.m. ; 26, M. M., took 1 drop 2d cent, at 2.35 p.m. ; 27, A. M. Cushing, New Eug. Med. Gaz., vol. xi, p. 408, inhalation of 1st dec. attend.; 28, Dr. Morrison, Month. Plom. Rev., 1877, p. 302, symptoms caused by evaporation from a two drachm glass-stoppered bottle, which had been shaken in the morning ; 29, N. F. Cooke, Cincin. Med. Advance, 1878, p. 269, effects of two strong inhalations from a vial containing 4 ozs. of the crude.

Head p. 292

VertUjO. Dizziness; (after seventeen hours and a half )

Vertigo on rising in the morning (second day),’

Dizziness and nausea (immediately)

Decided dizziness and heaviness of the head (after thirty-five minutes)

Dizziness, with slight nausea, worse when the eyes are closed (after first dose)

Genevill Head. Great rush of blood to head and face

Head heavy (in three hours and a half ),'■

Dulness in head (after two hours)

Violent exercise during one minute produced a dull headache (thirty-six minutes after 40 drops); later the influence of heat (closet heated by gas) caused the dull pain to extend from temple to occiput, principally left-sided; the dull pressing feeling in occiput remained two or three hours

Headache and nausea on rising in the morning (second day)

Pressure (very .-light) in head, forehead, and temples especially (twelve minutes after 40 drops) ; pressure slightly increased (seven minutes later)

Feeling as though a band were drawn tightly about the head (after eight hours and a half)

Immediately an intense, crushing pain upon the head, which seemed to gather into a feeling of confusion, that for a moment threatened to make me unconscious. At that moment I became aware of a quick, somewhat sharp throbbing in the head, and an intense glowing of the face, with general perspiration, especially marked in palms of hands, where it was quite visible. There was also a sen.-^ation as though the scalp were jerked forward from the occiput towards the forehead, ceasing just before it reached that point; this was repeated a number of times. Was conscious of a dull headache for some time, perhaps three hours

ForeJiefld. Heaviness and pressure outward in forehead and temples (immediately); pain in head increased, accompanied by stupid, drowsy sensation and burning in the stomach, and up to the throat. During and after a walk of a mile, two hours after inhaling the drug, the heaviness and pressure in the head remain ; entirely passed off two hours later

Great heaviness in front part of head ; head would fall first to one side, then to other (after first dose)

Severe, dull, heavy pains across the forehead, without marked external heat, in the morning (.second day)

Dull feeling in the forehead (after one hour and a half )

Slight headache in the frontal region (after two hours),“.-^Slight oppression at the front-parietal suture, then proceeding to the frontal bone (sixth day)

Temples. Slight pain in right temple (after four hours)

Pressure in the temples

Pressing pain in the temples

Painful pressure outward in the temples, especially in the left, with dull, heavy aching pain in the occipital region, extending to the nape of the neck (while walking), (first and second days)

Slight throbbing iu the temple (twenty-one minutes after 40 drops')/®.

Throbbing in the temples (after two hours)/

Vertex and Parietahs. Violent throbbing in top of head and in carotids; redness and heat in face, head, and neck

Headache on left side, parietal region (after four hours),‘^f

Suggestion of pain in right side of head (after forty minutes)

Pain iu right oeci})ital region (in five minutes)

Pain in occiput, mostly on right side (after three-quarters, and one hour and a half )

Pain iu occiput, aggravated by heat of room and by writing ; when the forehead was painful, the pain in the occiput was less severe (after two hours and a half)

Dull pain in occiput (after twenty minutes)

Dull pain in occipital region of narrow extent (after four hours)

Boring pain in occiput (after half an hour)

Face p. 293

Dull, heavy pressure over the eyes, as if a heavy weight were within (after first and fourth doses^'f

Dull pain over the eyes (after eight hours and a half)

Slight pain over both eyes (after ten minutes)

Aching pain in the eyes when in the sunlight, with profuse lachrymation, followed by snee2ing (second day)

Pain back of eyes on looking at near objects (after three hours)

Sudden sharp pain under left eye (iu five minutes)

A decided twitching under the outer canthus of left eye (after second dose)

l^isiou, Dimness of sight (sixth day)

Everything appears as if trembling, wavering (second day)

Slight blurring of letters when reading (thirteen minutes after 3 drops)

He confirms Pick’s observation (also made by others) as to objects appearing yellow after inhalation

Nose p. 293

Constant desire to sneeze (after three hours and a half)

Catarrh and dysphagia (sequelae of a recent attack of diphtheria) entirely relieved during the action of the drug, but returned after its effects had passed off

Slight epistaxis from left nostril (after one hour)

Numb feeling in nasal bones

Eyes p. 293

Face flushed,’; (after eight days)

Face flushed and hot (in five minutes)

After a few minutes the face became very red, and the heart’s action violent, the pulse rose 30 or 40 beats in a minute ; this symptom disappeared in one or two minutes

Burning sensation iu face (after half an hour and two hours)

Burning of right cheek, extending up into eye, and around to right ear (after forty minutes)

Creeping in left cheek (after four hours)

In a few minutes a slight creeping sensation in right cheek, below malar bone, which was momentary ; ten minutes later, twitching and creeping under left eye, also slight and momentary

Throat p. 293

Sensation in the throat, which produced a desire to cough, similar to that produced by tbe fumes of a burning match

Awoke about 5 P.M., with an extremely dry and parched sensation in throat and mouth ; arose to rinse my mouth with water, and in doing so, noticed a marked stiffness and dryness of the lips (second day)

Feeling of constriction of throat, as though it were closing up; relieved by motion

Feeling of constriction in the throat, and sensation as if growing up

Left tonsil considerably swollen and inflamed (after two hours)

Stomach p. 293

Loss of appetite (second day)

Eructations (after forty minutes)

Nausea (after seventeen hours and a half)

Slight nausea at first, and in ten minutes inclination to vomit

Fulness and pressure in stomach, with belching of gas

Burning in stomach (after two hours)

Plot, burning sensation in stomach, with empty eructations (after first and fourth dose)/l

Crampy pains in epigastric region (after two hours)

Abdomen p. 294

Slight oppression near the liver (after second day)

Griping pain in umbilical region

Crampy pains in umbilical region (second day)

Slight distension in the abdomen, with dull pain (after four hours),'A

Slight rumbling in the bowels (after fifteen minutes)

Bowels moved with a rumbling, leaving a feeling of emptiness afterward (after half an hour)

Slight griping pain in the bowels (after eight hours and a half

Severe colicky pains in the abdomen, increased when lying down (after first dose)

Contraction of the muscles in the lower part of the abdomen, as though they were all being drawn together over the region of the uterus; the region of the uterus, fallopian tubes, and ovaries felt very hard on pressure (after seventeen hours and a half)

Respiratory Organs p. 294

Hacking cough (five minutes after first inhalation, and again three-quarters of an hour after)

Could hardly breathe for about a minute

Oppressed, difficult, and rapid breathing; feeling as if a weight were on the sternum, the oppressed breathing remained during and after a walk of a mile, two hours after inhaling the drug; entirely passed off two hours later

Feeling of suffocation from palpitation of the heart

Chest p. 294

Oppression of chest on walking about (after four hours)

Sense of oppression in the chest, especially at the lower part of the sternum (second day)

Oppression at the end of the sternum on going downstairs (after two hours and a quarter),^k

A peculiar sensation in right lung or chest, not exactly a pain, however (soon)

Drawing pain in left side between the seventh and ninth ribs, short but frequent (second day),^'k

Slight, dull, aching pain in right chest (after one hour and a quarter) ; pain more severe (after two hours)

Sharp pain in region of heart, relieved by eructations, which continued several days

Pain in left side in region of heart, extending around to the back (after two hours)

A short contraction at the left of the heart, ill-defined (after second dose),^k

Heart and Pulse p. 294

Stitching pains in the cardiac region and feeling of constriction

Very violent palpitation

After exercise, palpitation of heart more violent than usual after the same amount of exercise

Beating of pulse distinctly felt in fingers (after one hour and a halfPulse accelerated (sixth day)

Pulse accelerated, full and hard (second day)

Pulse increased about twelve beats in the minute, but I was unable to count it at once, owing to the confusion of the head

Pulse accelerated by 10 or 12 beats (fifteen minutes after first dose); rose 20 beats, remained so a few minutes, and then gradually fell to normal standard (twelve minutes after 40 drops)

Pulse 60 (after three hours)

Pulse accelerated from 60 to 72. hard and full

Pulse 64, normally 70 (after second dose)

Pulse 83 (before taking medicine) ; 63 (in twenty-five minutes) ; 73 (after two hours); did not return to usual state for two days

Pulse 63 (before medicine) ; 68 (after ten minutes) ; 65, not regular (after twenty minutes); 68 (after thirty minutes) ; 63 (after one hour and a half); 70 and irregular (after one hour and three-quarters); 65 (after two hours); 63 and quite full (after two hours and threequarters)

Pulse not accelerated but irregular in action, almost impossible to count

Neck and Back p. 294

Stiffness and pain in right side of neck and right shoulder, extends down right arm to wrist, neuralgic or rheumatic in character (in five minutes); pains return (after three hours and a half ),^h

Twinges near the dorsal vertebrae (after four hours)

Pain and weakness in lower lumbar region, in the morning (second day)/

Upper Extremities p. 295

Trembling of the limbs, with feeling of weakness

Weakness in the limbs

Lameness and soreness of muscles of arms and thighs entirely cured, perhaps by time

Soreness of extensor muscles (after four hours),^h

Uneasy feeling in extremities (after half an hour)

Superior Extremities p. 295

Slight discomfort in right shoulder (after twenty-seven minutes)

Lameness of flexor muscles of right arm (after forty-five minutes')

Pain and stiffness right arm, particularly near wrist, much increased by motion; effort of bending the arm or of writing very painful (after one hour and a half)

Drawing, tensive pains in the wrist and finger joints of left hand

Pulsations distinctl}" felt in the tips of the fingers

Inferior Extremities p. 295

Stiffness in lower limbs (in three hours and a half)

Rheumatic pains in left leg and knee, followed by soreness in right arm and shoulder; then lameness in right scapula (after four hours)

Sharp pain in the calf of the left leg (after eight hours and a half)

Generalities p. 295

Ladendorf and Dr. O. J. B. Wolf investigated the action of Nitrite of amyl on blood by microscopic examination. A drop of freshly drawn blood was placed on a slide under the objective, and a little spill of wood moistened with Amyl nitrite approximated. When the spill was 1.5 to 2 millimeters (jgth to /gth inch nearly) distant from the blood-drop, there immediately occurred, independently of the movements of the blood-fluid, a violent agitation of the blood-corpuscles in the neighborhood of the spill; moving rapidly away from it, and returning, rather, less quickly, to their old place, in a curved line, and then madly hastening (sic) to begin the same game again. Simultaneous experiments with indifferent bodies gave only the ordinary physical movements. The direct conract of the Amyl nitrite is said to have produced solution of corpuscles, with formation of lakelike pigment (color of winter cherry). The vapor first made the corpuscles pale, then dissolved them. Ladendorf did not employ a moist chamber; but he ascribes the whole of the effects of Amyl nitrite to this action on the blood-corpuscles, causing a backward pressure on the pulmonary arterial system first, and then on the systemic, finally inducing venous congestion as a natural consequence

Immediately felt a sense of fulness of head and flushing of 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. I now felt myself sinking to the floor, which seemed a voluntary act, for I eased my descent by means of two tables between which I was standing, lowering myself gently until stretched at full length ; my last conscious act was the endeavor to hold the head erect lest the surcharged cerebral vessels should become yet fuller. My first act of returning consciousness was to recognize my attendant, who was giving me Chloroform. 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. I was informed that my “face and eyes were a deep, livid red color and that I “looked horribly

Entering the room at 10.25 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 conjunctivte, with injection of the ocular conjunctivse, and dimness of vision as if caused by a film. Subacute smartings in precordial region ; then in right renal region ; then in right axilla; then at mid-sternum ; then in lumbar region; then in lower lobe of right lung, at apex of the heart, and in lower lobe of left lung, with tenderness on pressure. Increasing dyspnoea, with sneezings, 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, whereupon I beat a retreat (first day). On awaking the pains returned with increased intensity, especially in spine, lungs, and conjunctivce; with shifting pains, caused by movement, on dorsal surface of right hand, on left patella, and from left thumb to axilla; with catarrhal symptoms, and severe frontoorbital cephalalgia. Many of these symptoms returned, with varying intensities, during the day ; at times accompanied by sighing respiration. They were intensified by the odor of being again inhaled. Urine clear, acid ; sp. gr. 1014; free from albumen and phosphates; light cloud of an oxalate (probably lime), and distinct traces of sugar. Pulse (sitting) 78 to 84, feeble (second day). During morning a dull aching in cervical region, which gradually moved to suboccipital region, and then passed away. During the evening, smarting)gs in the eyeballs, with injection of the coujunctivse. Urine clear, acid ; sp. gr. 1020; traces of oxalates and sugar in marked quantity (third day). After rising, sneezed violently three times; severe occipito-frontal headache, felt mostly in suboccipital region; smarting of the conjunctivse and weakness of vision. Urine clear, free, acid; sp. gr. 1016; saccharine. Pulse (sitting) 80; general lassitude (fourth day). Occipito-frontal headache, with achings in right renal region ; smartings of conjunctivse. Urine clear, free, acid; sp. gr. 1020; saccharine (fifth day). Severe occipito-cervical achings, with increased frequency of the renal achings; smartings of conjunctivse. Urine clear, free, acid; sp. gr. 1020; abundance of sugar. Pulse (sitting) 70, regular (sixth day). Constant occipital headache, and achings across loins. Urine clear, acid ; sp. gr. 1018 ; less sugar (seventh day). Achings remain, with weakness of eyes, and smartings of conjunctivse. Urine clear, acid ; sp. gr. 1016; traces of sugar (ninth day). Slight occipital headache, and smartings of conjunctivse; returns loin achings on waking, and on lying down at night. Urine clear, acid ; sp. gr. 1018; traces of sugar (twelfth day). Remains of suboccipital and loin achings, increased by fatigue. Urine clear, acid ; sp. gr. 1012; mere trace of sugar. Pulse (sitting) 66, regular, feeble (nineteenth day). Weakness of vision persists. Urine clear, acid; sp. gr. 1014; traces of sugar. Pulse (sitting) 68, regular (fortieth day). The achings mentioned were increased by fatigue, and were most marked during the evenings,'

General weakness, with tendency to perspire easily on slight exertion (after nine hours)

During the day, general lassitude; did not feel like doing anything. This may have been owing to the weather (second day),'■

Restless (second day),^h

Great restlessness and uneasiness

Stiffness as if from having taken cold (in five minutes),'■

Trembling sensation all over, and cannot sit still for fear of something dreadful happening

Tingling sensation in different parts of the body (after one hour and a quarter)

All symptoms relieved by exercise out of doors

Skin p. 297

He advises the lips, nostrils, etc., to be guarded from direct contact, as vesication is apt to arise if they are not so protected

Sleep p. 297

Drowsiness (second day')

Very drowsy (after forty minutes)

Confused and drowsy (sixth day)

Overpowering drowsiness, lasting more than an hour (after first dose)

Sleep restless, full of anxious dreams; frequent waking, with severe pain in temples and in the stomach and bowels (first night)

Fever p. 297

Slight chill crept over the back and sides (sixteen minutes after 20 drops)

His observations, embracing more than forty cases, were made partly upon sane persons, and partly on those recovering from different p.«ychoses. The time selected was generally from 3 to 5 p.m., or after 8 P.M. The thermometer was placed in the mouth, between the cheek and the superior maxilla. The general result is, that the temperature always rises after the inhalation. Many circumstances affect the amount of this rise, such as the quantity of vapor inhaled, the surrounding atmosphere, the contraction of bloodvessels, individual peculiarities, etc.; so that two persons with the same initial temperature may show differences of 0.53° Cent. It is interesting that this rise can generally be demonstrated for from one to two hours. A table of thirty-six cases is given ; the smallest maximal elevation was 0.1° Cent, (in three cases) ; the highest maximal rise was 1.88° Cent, (one case); the mean rise was 0.39° Cent, (thirty-six cases). This elevation is very evident in the course of the second minute of inhalation. The purer the preparations inhaled, the more evident the effect. The effect on his pupils was not very uniform. In all cases when simultaneous observations were made, the axillary temperature rose correspondingly

Hands moist, head and body felt warm, especially the abdomen (thirteen minutes after second dose) ; greater warmth especially in the chest (thirty minutes after second dose) ; heat was felt in head and along oesophagus to stomach; heat remained over half an hour (five minutes after 10 drops); heat was experienced principally in stomach; skin moist (ten minutes after 20 drops)

Redness and heat of head, face, and neck, with violent throbbing in top of head and carotids

Heat in face

Slight heat in face (after twenty minutes)

Heat and redness of face (immediately)

Marked feeling of heat in face, with flushed face (after three-quarters of an hour)

Heat in left ear (after forty-five minutes)

Profuse perspiration on hands

Skin moist, free perspiration during moderate exercise (second day)

Though not warm perspiration started freely, cold chills at the same time running down my back

Conditions p. 297

Aggravation.

(Morning), On rising, vertigo; headache; nausea.

(Heat of room), Pain in occiput.

(Lying down). Griping in abdomen.

(Motion), Pain and stiffness iji arm.

(Writing), Pain in occiput.

Amelioration p. 297

(Eructations), Pain in region of heart.

(Motion), Constriction of throat.