Amylenum nitrosum

Volume I — Special Symptomatology

(Nitrite of Amy I.)

Pharmacology. — This drug was discovered by the French chemist, Balard, in 1844, and the attention of physiologists was called to it, in 1859, by Guthrie. But it was not until 1865 that Dr. Richardson introduced it to the profession.

It is a yellowish, oily, very volatile liquid, of a very penetrating, persistent, fruity odor; very highly inflammable; is lighter than water, boiling at 182° F. It may be prepared by gently heating Amylic alcohol (Fusel Oil) in a retort, with nitric acid, removing the heat as soon as bubbles form, repressing the 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 170° F.

Officinal Preparation— Alcoholic dilutions, on the centesimal scale. (Usually inhaled, a few drops at a time.)

Analogues:— Agaricus,(?) Belladonna, (f ) Ether; Glonoine. (See Therapeutics, for symptoms and clinical remarks.)

Volume I — Appendix

(Nitrite of Amyl.) Phakmacology. — See page 42 of Symptomatology.

Head.

• Beating, throbbing, bursting sensation in the head a id ears, with

constriction of the throat and heart.

Face.

° Flushing and perspirations of the face and neck of women at

the change of life. ° Neuralgia of the fifth nerve. ° Supraorbital neuralgia.

Eyes.

Under the ophthalmoscope the veins of the disk were seen to become enlarged, varicose and tortuous.

Ears.

Much throbbing in the ears.

• Tinnitus aurium.

Nose.

• Epistaxis.

Throat.

Choking feeling in the throat on each side of the trachea, along the carotids. Feeling of constriction. The collar seemed too tight, with desire to loosen it.

Stomach.

° Spasm of the stomach (Dr. Anstie), very successful in seasickness (by inhalation and internally).

° Hiccough.

Generative Organs. ° Violent dysmenorrhea with scanty menstruation.

Chest and Respiration.

A feeling of constriction in the throat extended to the chest, and produced dyspnoea and asthmatic feeling in the larynx a,nd trachea with desire to eructate.

° Asthma, it removes the dyspnoea immediately and prevents its return.

Volume II — Special Therapeutics

The Nitrite of amyl is a singular and unique drug, having very little affinity for, and no close resemblance to, any other agent in our Materia Medica.

Its only similarity to Glonoin is in the arterial relaxation it causes, which simulates congestion. But the arterial turgescence of Glonoin is active and forcible, and always accompanied by painful sensations.

The congestion of Amyl is not due to any forcible rush of blood

into the cerebral arteries, but a passive filling up, owing to relaxation of those vessels. Pain in the head is rarely present during the effects of Amyl, although it sometimes occurs at the height of its effect. It differs from Belladonna in the transient character of the cerebral fulness. Its action is of shorter duration than Glonoin, lasting but a minute or two in most cases. Its rapidity of action is another peculiarity of this drug. In thirty or forty seconds, whether inhaled, subcutaneously injected, or swallowed, its action begins, and shows itself by flushing the face and starting the perspiration from the head, face, and neck. This property makes it more valuable than Ether or Chloroform in cases of severe internal spasms with pain, such as angina pectoris, or in epilepsy and asthmatic sufferings.

The most prominent symptoms induced when it is inhaled by man in moderate quantities (a few drops) are a sense of fulness and distension of the head, amounting at last to severe pain, and accompanied at last by intense flushing of the face, a deep, labored breathing, and an exceedingly rapid, violent action of the heart. The succession of these phenomena is so rapid that often they seem to be simultaneous ; but it is said that the cardiac disturbance is sometimes very distinctly manifest before the other symptoms.

Dr. H. C. Wood, in his “ Materia Medica and Toxicology,” says of its method of action : “ I have found as the results of numerous experiments made in the ordinary methods, that the diminution of reflex activity and of voluntary motion, which undoubtedly occurs in toxremia from this agent, is chiefly spinal in its origin ; since, after death, the nerves and muscles preserve, though in an impaired condition, their functional power. In the motor centres of the cord, the Nitrite is a direct and powerful depressant at the same time that it exerts a similar but much less pronounced action on the nerves and muscles, decreasing but not destroying their functional life. The diminution of reflex activity is never preceded by a stage of functional excitement. In some animals convulsions do occur, especially when the drug is administered by inhalation ; but they are in all probability cerebral, not spinal, and due to the asphyxiating influence of the poison. Over the sensory nerves and centres, Nitrite of amyl has but little power.

They are among the last portions of the body to be affected, sensation being intact until near death, so that the drug is in no sense an ancesthetic. The cause of death appears to be due to the failure of power in the cord or respiratory centres higher up.

The fact that it is not an anaesthetic does not militate against its power to relieve the pain of angina pectoris and similar painful affections. Angina is now supposed to be due to cramp , or a spasmodic contraction of the cardiac muscle. Cramp may cause the most agonizing pain known to man. A remedy that removes the cramp relieves the pain, not by any anaesthetic power, but by relaxing the spasmodically-contracted muscle.

Wood proves quite conclusively that its action on the arterial system is not that of a motor -stimulant. Its action is peripheric , not centric. In other words, its apparent stimulating action on the heart is reflex. It paralyzes the arterioles, dilating them to such an extent that the heart gathers up and exerts its force violently for a short time ; but if the inhalation be persisted in, its impulse constantly grows weaker, until its power is become extinguished.

After this examination of its physiological and pathological action, the question arises : To what abnormal conditions and symptoms is the Amyl homoeopathic? It is primarily homoeopathic to those cases where there is dilatation of the arterioles, and a redness and flushing of the surface of the body, not due to any primary disturbance of cardiac power. The action of Amyl, according to eminent experimenters, is peripheric. It first exercises a paralyzing influence on the coats of the arterioles. This paralyzing influence spreads to the centres, and the heart itself is the last to feel its influence.

This singular and unique quality of Amyl makes it one of the very few remedies which in their action correspond with the physical effects of the mental emotions. If you study the effects of excessive joy, you will see a remarkable resemblance to the action of Amyl, namely, a sudden flushing of the face, a distension of the peripheral arteries, a quick, bounding pulse, and an increase in the number and frequency of the heart-beats. But during this period of increased action there is really a diminution of arterial pressure at the surface of the body. Sometimes after this

Amyl-flushing has lasted a few moments, the face changes to paleness and coldness, and a faintness supervenes, and the same occurs after the flushings of joy. Other mental emotions have a similar action. Joy is only one example. Amyl is homoeopathic to all such symptoms.

It is a singular and suggestive fact, and makes us very hopeful of the final acceptation of the law of Similia by the best men of all schools, that the foremost man in the allopathic ranks in England, Dr. Sidney Ringer, recommends, from his own actual experiences, the Nitrite of amyl for the very symptoms and conditions which it primarily causes. I quote from his “Therapeutics” — a splendid work, which should be in the hands of every homoeopathic physician. (The italics are my own.) He says :

Dr. Brunton shows that it relaxes the whole arterial system, probably by partially paralyzing the sympathetic ganglia and motor nerves. This paralyzing effect of the arterial system is well shown by the sphygmographic tracings, the flushing of the face, and the increase in the size of visible arteries like the temporal, which often becomes notably large, sometimes, indeed, being doubled in size, and branches previously invisible become plainly apparent; and by the interesting fact observed by Talfourd Jones, who, while cupping a patient over the loins and finding that the blood would not flow, administered Nitrite of amyl by inhalation, when the cuts immediately began to bleed freely. After an inhalation the larger arteries are slower in recovering their normal size than the capillaries, a phenomenon well observed in the temporal artery, which remains enlarged half a minute or longer after the blush has quite left the face.

Dr. Brunton first employed Nitrite of amyl in angina pectoris with signal success, and found it more effective than any other remedy in this painful and dangerous disease. During an attack, his patient suffered from throbbing of the heart and carotids as high as the ears, with severe praecordial pain extending to the right arm. The usual characteristic “sense of impending death” was absent. The pulse was slightly quickened and the sphygmographic tracing became modified, for, as Dr. Brunton states, “ as the pain increased the curve became lower, both the ascent and descent more gradual, and dicrotism disappeared. This form of curve clearly indicates that the arterial tension is much increased, and can, I think, be due only to contraction of the small systemic vessels.” The increased tension first led Dr. Brunton to employ Nitrite of amyl. In the case in question he considers that the attack consisted of spasmodic contraction of some, if not all, of the small systemic and pulmonary vessels, which state of arterial tension gave way on inhaling the Nitrite, and the pain then disappeared. On the recurrence of an attack, the patient inhaled the Nitrite of amyl, and always obtained instantaneous relief.

Dr. Anstie reports a well-marked case of angina greatly relieved by this

treatment. He says : “ The first sniff produced, after an interval of a few seconds, the characteristic flushing of the face and sense of fulness of the head ; the heart gave one strong beat, and then he passed from the state of agony to one of perfect repose and peace, and at his usual bedtime slept naturally. This experience has, I am happy to say, been repeated on several occasions, and with this fortunate result, that so confident now is the patient of being able to cut short the paroxysm that he has discarded all use of Ether, and greatly reduced his allowance of stimulants.” Dr. Talfourd Jones also finds it very useful in angina. Since the previous edition of this work, Nitrite of amyl has been largely used in angina, and with considerable success. Indeed, in most cases no other remedy affords so much relief. As might be expected, it is not uniformly successful. Thus, in one case due, as we discovered after death, to aneurism of the heart immediately below the aortic valve, an inhalation always arrested the pain, but it returned after a few seconds or minutes, even if the administration were several times repeated, and was as severe and lasting as when no Amyl was used. In another case, whilst it gave great relief, always arresting the paroxysm, it took ten minutes to effect this, and was in no way superior to a full dose of Ether, which the patient preferred, as the Amyl produced so much giddiness and sensation of fulness in the head. In three other cases, however, it proved strikingly successful. In one desperate case the slightest exertion brought on intense pain ; but by the aid of Amyl the patient could always at once cut short the attack, so that now he can walk several miles, though he is obliged during his journey to employ the Amyl several times. It has appeared to me that by at once checking the paroxysm the attacks come on less frequently and less severely, and after a time a much smaller quantity suffices to control the pain ; so that Amyl really contributes to the prolonged relief of these unhappy patients.

Dr. Talfourd Jones found it remarkably successful in very severe attacks of asthma, removing the dyspnoea immediately and averting its return. Others have found it very useful in asthma. He found it useful also in a case of cardiac dyspnoea, accompanied by extreme anasarca, due to a dilated and hypertrophied heart.

Dr. Sanderson suggests that it may be a relaxer of spasm generally, and Dr. Anstie has used it with success in cases of spasm of the stomach.

Dr. Talfourd Jones advises inhalation of the Nitrite in syncope, and thinks it should be of service in the paroxysm of whooping-cough. It is useful in neuralgia, at least in neuralgia affecting the fifth nerve. It often eases the pain at once, and in some cases a single administration has averted further attacks, but so signal a result as this is probably exceptional. Dr. Richardson finds that Nitrite of amyl arrests in frogs the convulsions due to Strychnia, and in this way he has saved their lives ; and he advises a trial of the Nitrite, either by inhalation or subcutaneons injection, in strychnia poisoning and tetanus. In the foregoing diseases it is better to administer this remedy by inhalation, for, according to Brunton, it will not answer with anything like the same certainty when given by the stomach ; for, in the striking case of angina pectoris just cited, he gave ten minims in brandy by the stomach, with the effect of staying the pain for only a short time, but a single inhalation afforded perfect and permanent

relief from the attack. It should be borne in mind that it affects some persons much more than others ; one individual being able to inhale five or ten drops from a handkerchief, or to breathe the fumes from the bottle held close to the nose, while another on smelling a whiff from the bottle held at a distance will become affected with great giddiness, much mental confusion, and general weakness. Jones directs five or ten drops poured on a handkerchief, or the fumes from the bottle held close to the nose, to he inhaled till the pulse quickens, when the inhalation should be discontinued ; but this plan is far too potent for some persons, especially feeble and sensitive women, who in the first instance should inhale a much weaker dose. As J ones points out, patients become habituated to it so that after awhile it must be inhaled several times before it affords relief. This habituation is well exemplified in the internal administration of the remedy. Jones also finds that by exposure it gets “flat” and loses its efficacy.

Nitrite of amyl is generally considered a powerful and even dangerous remedy, whose administration must be watched with great care, and only a measured quantity employed. I am sure it is not nearly so dangerous as is generally imagined, though it is true that nervous, sensitive women are far more powerfully affected by it than men. No doubt its administration at first should be conducted by a doctor, in order to ascertain how far the patient is susceptible to its influence, and that the patient may learn when he ought to discontinue the inhalation. But after one or two inhalations, patients soon learn how to administer it to themselves. I have now five patients with angina pectoris, who always carry with them a small bottle of this medicine, and on the first warning of an attack they at once begin to sniff at the bottle, whether walking or standing. This they have done for months, and one patient for just a year, using the inhalation many times daily, so that he consumes about two drachms a fortnight with still unfailing relief. Except in relieving the angina, the Amyl seems to produce no other effect on the system.

Dr. Jones recommends a trial of it in epilepsy. To an epileptic patient, who, in addition to severe and repeated attacks, suffered from much mental confusion, and was haunted many times a day with an indescribable dread and sensation as of an oncoming fit, although it came on only once or twice a week, the author gave it in three-drop doses thrice daily, and an additional dose on the earliest warnings of a fit. Amyl lessened considerably the frequency of the fits, and entirely removed the harassing sensations. Dr. Crichton Browne has lately published some valuable observations on the use of Nitrite of amyl in this disease. In two rabbits made artificially epileptic, he prevented the oncoming of the convulsions, which otherwise follow the application of the electrodes to the brain, by making them inhale Nitrite of amyl. By the same means he has likewise arrested epileptic attacks on the occurrence of the aura before the onset of the fit, and has even cut short the fit after its commencement. He has, too, obtained very satisfactory results in that form of epilepsy called status epilepticus — a condition consisting essentially of a succession of fits, linked together by intervening unconsciousness, the fits recurring with greater frequency till at last no sooner is one fit ended, nay, before it has finished, another fit begins. Fits like these he has arrested, and has rescued several patients out of this desperate

plight. Amongst other successful cases, Dr. Weir Mitchell reports one where the remedy was used immediately the aura was perceived, and other cases where the spasms lasted for hours, one fit following another. These two gentlemen give it by inhalation. Since my last edition I have given this remedy with considerable success to several epileptic out-patients, in whom the attacks have been very frequent. In some it has appeared to be more useful than full doses (20 to 30 gr.) of Bromide of potassium thrice daily; in another case, whilst it decidedly lessened the frequency of the attacks, it was less serviceable than Bromide of potassium. I have given it in two to five minim doses suspended in mucilage, every three hours or three times a day, and have not found these doses produce any unpleasant effects in these epileptics, nay, in some cases they have not even caused flushing, whilst in other cases patients have told me that they flush with each dose, but only whilst swallowing it.

The patient should take the medicine whilst lying down ; and as some patients, especially women, are very readily affected by the drug, it is well in the first instance to give it in smaller doses. But until the remedy is pushed to two and in some cases to five minims every three hours, I have failed to obtain conspicuous results. Dr. Crichton Browne maintains that epileptics are more sensitive than others to inhalation of Amyl administered in this way. I imagine that this medicine will be useful only where the attacks are frequent, and that it cannot be given thus, where they occur only at comparatively long intervals of three weeks or a month.

Inhalation of Nitrite of amyl has been recommended in sick headache, and one successful case is reported by O. Berger.

The author has used this remedy extensively with considerable success in cases of the following kind: A woman, perhaps from the sudden arrest of menstruation, 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 backs of the hands, are often deeply reddened, the veins of the hands in some cases dilating to double the previous size. Sometimes, although the patient feels deeply flushed, 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. Sometimes they occur chiefly at night, greatly disturbing sleep. 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 axe followed by much prostration, the patient feeling scarcely able to rouse herself.

After the heats pass away the skin becomes cold and clammy, and may turn very pale. The least exertion or excitement may bring on these heats, and such a patient generally complains of cold feet and sometimes of 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 much broken, the patient waking

with frequent starts, and in the morning feeling unrefreshed. In many cases palpitation or “ fluttering at the heart ” occur on the slightest excitement, or even without apparent cause.

Nitrite of amyl prevents or greatly lessens these flushings or “heats,” and averts the profuse perspiration, throbbing of vessels, and great prostration. Sometimes it warms the feet and hands, and controls the fluttering of the heart, but in most cases it leaves these symptoms unaffected, and for their cure other remedies, as iron, are required. Amyl removes also giddiness, confusion of mind, heaviness in the head, and even headache; it generally produces calm, refreshing sleep.

When the flushings and perspiration are slight this remedy is scarcely needed ; moreover, the perspirations are generally considered vicarious and beneficial at the change of life. The symptoms, in many cases, form only a minor part of the troubles of the patient, who may complain of great sinking at the epigastrium, or severe pains in different parts of the body, and other sufferings incident to this period, over which Nitrite of amyl has little if any influence. But when flushings, etc., constitute the chief part of the patient’s troubles this medicine is most serviceable.

The Nitrite of amyl in ten days completely cured the following singular case of a woman who had been horribly tormented, for three years, with attacks, repeated several times daily, of severe burning sensation over the loins, from whence a glow of heat spread over the whole body, followed by perspiration. The burning sensation was so unendurable that she was constrained to open the window at night even in winter, and sometimes to rush out of doors.

For the symptoms thus described the author has generally administered this drug by the stomach, though inhalation answers as well. In respect of dose it must be borne in mind that, like Glonoin (Nitroglycerin), its effects vary very greatly with different persons. One, two, or even three minims produce in some only flushing of the face and slight giddiness, while in others even a drop will induce various disagreeable symptoms. Thus one woman immediately after a drop dose turned deadly pale, felt very giddy, and then became partially unconscious, remaining so for ten minutes. In another patient the same dose produced a sensation as if “ a vapor spread from the throat through her head,” and rendered her quite powerless for one or two seconds. A third of a minim dose sometimes excites great nausea or a tickling in the throat ; and one delicate woman after one-thirtieth of a drop passed for a few minutes after each dose into a trancelike state, everything to her seeming unreal, and the breathing becoming rather panting. The author began with a minim dose, but was obliged to reduce this quantity, and he ultimately found that, for the most part, those patients can bear one-third of a minim without any disagreeable symptoms, but that a tenth, nay, even a thirtieth of a minim will in some patients produce the desired effect on flushing. It may be dissolved in rectified spirits, two minims to the drachm, and of this three to five drops should be taken on sugar every three hours, with an additional dose as soon as a flush begins. Belief generally ensues immediately, but sometimes not till the medicine has been taken for a week. As the patient grows accustomed to the remedy the dose must be increased.

Dr. H. L. Waldo, of Troy, N. Y., in a paper on the Nitrite of amyl, takes a somewhat different view of its action than I have given. I quote his remarks, and also his clinical observations:

Its power over all forms of spasmodic diseases is exerted by virtue of its direct action on the ganglionic centres of the sympathetic system, and not by any stimulating or paralyzing action on the capillaries, or any direct sedative action on muscular tissue, as certain allopathic physicians would have us believe. The vasomotor nerves, which are a part of the great sympathetic system, supply the muscular coat of the arteries, and thereby regulate the expansion and contraction of these tubes, and so determine the amount of blood that shall pass through them. It is well known that all spasmodic diseases, as asthma, chorea, epilepsy, etc., are due to a deficient innervation, and in turn this deficient innervation is due to a deficient supply of blood to the nerve centres ; and this deficient supply is due to an irritation of the cerebral ganglia, which is transmitted by the vasomotor nerves to the coats of the arteries, causing them to contract. Now, Nitrite of amyl acts directly on the cerebral ganglia of the sympathetic, and produces a commotion in the circulatory system similar to that which occurs in an epileptic fit. “ When it is given rapidly the lungs and brain are found blanched, and the left side of the heart empty, though the right cavities are gorged with blood. If given slowly it leaves a congested state of the brain and lungs, and blood is found in both sides of the heart.” — “ United States Dispensatory.”

We see that its action falls almost entirely on the nerves of the arteries, scarcely any at all upon those of the veins, thereby greatly modifying the supply of blood to the brain, but not greatly influencing its return to the heart, and this again is just the state of things found in epilepsy.

In chorea and spasmodic asthma the spasm is due to the same cause, though it differs in extent. In syncope, too, we find the same condition of the cerebral circulation to which Nitrite of amyl has just been proved to be so peculiarly homoeopathic, and in this affection it has been found very useful by allopathic physicians. It is a powerful cardiac stimulant. The excitement which it produces is followed by diminished but not extinguished action of the heart. A reduction of the respiration and circulation so extreme as to resemble trance may be induced and maintained for hours. Muscular action is at first “ wildly excited,” and then subdued by its use.

I fully believe that if administered just before an epileptic fit is to occur it will prevent the spasm of vessels, and hence prevent the fit every time ; and in several cases that have come to my knowledge it has thus far proved permanently curative, preventing any recurrence of the fits. In a case of seven years’ standing, brought on by masturbation, now under treatment, the patient carries a vial of it in his pocket, and when the aura occurs takes a few inspirations from it, and thus far has not failed to throw off’ the fits, a good many of which would certainly have occurred but for this treatment. Two fits have occurred while he was asleep and could not use the remedy. I have used it in several severe cases of eclampsia or fits in children, produced by various causes, and with the invariable result of at once breaking the fit. In a case of meningitis caused by a fall, while the child was kept under its influence the fits were prevented or at once broken, but the child died in a few hours from the severity of the disease.

It may be inhaled directly from a small vial, or five or ten drops may be put on a sponge or small cloth, from which it may be inhaled. For children I make the first decimal dilution with alcohol, and put ten or fifteen drops on a handkerchief and hold it near the nose. — “American Journal of Materia Medica.”

Dr. H. C. Wood, in speaking of its use in angina pectoris , says: “ There is now abundant evidence of its value in relieving, almost instantly, agony which has resisted all other treatment, whether valvular disease or merely functional disorder exists.” He adds, however, that “in cases of advanced fatty degeneration, or of very great dilatation of the heart, I think its use would be attended with danger, owing to its effect upon the heart’s muscle.”

Here we have the opinion of one who only looks upon its apparent antipathic action and the administration of large quantities by inhalation. But we can view it in another light. It is homoeopathic to the very condition of debility alluded to by Wood, and in minute doses it may act promptly as a curative agent.

It will be remembered that we are warned against using Chloral in cases of weakened heart, because in large or toxic doses it paralyzes the heart. But it has been demonstrated many times, by myself and others of our school, that in small doses it actually strengthens failing cardiac power ; as witness the remarkable case reported by Drs. Swan and Helmuth, and quoted under “ Chloral.”

Nitrite of Amyl in Ague — Dr. W. E. Saunders, of Indore, calls attention to the value of Amyl nitrite in ague, and records a number of cases in which advantage has been derived from its use. The drug itself, he remarks, is inexpensive and goes a long way. He now uses Nitrite of amyl mixed with an equal part of Oil of coriander, to render it less volatile and at the same time to cover its odor. He regards it as the most powerful diaphoretic he has seen, and he uses it in all cases of fever to produce diaphoresis. The following is one of his cases : Mr. F. C. came for treatment about 7 p.m. in the cold stage of ague. Two minims of Nitrite of amyl were administered ; sweating came on in seven minutes. He lay down for half an hour to get cool, and then walked home well. He next morning took a dose of Quinine, and has had but one attack of fever without the cold stage since. Previous to this he had fever every day for one month, during which he took large doses of Quinine. Dr. Saunders observes that he does not mean to say that Quinine should not be used in the cases, for there is ample proof that it tends to check the return of the attacks, and removes to some extent the septic condition of the blood induced by the malarial poison, and this more especially if small doses of Opium be combined with it. In no ease did the Amyl fail to remove the attack in about one-third the usual time, and in most cases the fever did not return. The method of administration he adopts is this: Four drops of the mixture or two of Amyl are poured on a small piece of lint, which is given into the hands of the patient, and he is told to inhale it freely. He soon becomes flushed, and both his pulse and respiration are much accelerated, and when he feels warm all over the inhalation is discontinued, as the symptoms continue to increase for some time afterwards. A profuse perspiration now sets in, which speedily ends the attack ; in some cases, however, the cold stage merely passes off without any hot or sweating stage. — “ Indian Medical Gazette ” in “ The Practitioner.”

Pathogenesis.

The characteristic symptoms of Amyl, so far as we have gained the knowledge of them, have appeared in Allen’s “ Encyclopedia of Materia Medica,” vol. i, from which I quote them, adding a few which I have gleaned from other sources.

Through an inadvertence they were omitted in Vol. I, “ Special Symptomatology,” and are, therefore, appended hereunto.

Mind.

Anxiety, as if something might happen ; must have fresh air. Actual fright at the throbbing in the head, and a bursting-out feeling in the ears.

Mental confusion and a dreamlike state.

She passed for a few minutes, after each dose of one-thirtieth of a drop, into a trancelike state, everything seeming to her unreal.

Head.

Great confusion of the head, with vertigo.

Heat and throbbing in the head, with a feeling of intense fulness, with great heat and flushing of the face.

• Beating, throbbing, bursting sensation in the head and ears, with constriction of the throat and heart.

Visible pulsating throbbing in the temples, with sense of tension in the temples.

Sensation of something rushing upward, and throbbing in the vertex. Heavy, dull aching all through the head.

It causes no severe pain in the head until the acme of its effects is reached.

Sensation as if a vapor spread from her, through her head, and rendered her powerless.

Face.

Flushing of the face, a bright scarlet. It becomes intensely red and hot ; on passing off the face became paler than usual.

A sensation as if the blood would start through the skin of the face, with lachrymation.

The flushing of the face is attended by heat and perspiration of the head, face, and neck, while the hands and feet become very cold , and sometimes continue so for hours.

0 Flushing and perspirations of the face and neck of women at the change of life.

° Neuralgia of fifth nerve. ° Supraorbital neuralgia.

Eyes.

Protruding, staring eyes, with bloodshot conjunctiva.

Pupils dilated.

Sight very hazy, the outline of objects indistinct.

A spot on the wall appears of a yellowish hue, surrounded by a yellowish circle, and this again surrounded by a violet-blue halo, with undulating edges.

Under the ophthalmoscope the veins of the disk were seen to become enlarged, varicose, and tortuous ; the arteries small, but not abnormally so.

Urinary Organs.

It causes a very profuse flow of urine, which contains an abundance of Sugar (in animals).

Ears.

Much throbbing in ears. 0 Tinnitus aurium.

Bursting sensation in ears, as if membrani tympani of each ear would be forced out with each beat of the heart.

Nose.

Pressure over the root of the nose. ° Epistaxis.

Throat.

Choking feeling in the throat on each side of the trachea, along the carotids.

Feeling of constriction. The collar seemed too tight, with desire to loosen it.

Tickling in the throat.

Stomach.

Slight nausea, with uncomfortable feeling of the stomach.

Constriction and pressure over the region of the praecordia, as though he wants to rub it.

° Spasm of the stomach (Dr. Anstie).

° Very successful in seasickness (by inhalation or internally).

Chest and Respiration.

The feeling of constriction in the throat extended to the chest, and produced dyspnoea and asthmatic feeling in the larynx and trachea, with desire te eructate.

An indescribable feeling of fulness about the chest, with involuntary coughing, but the normal respirations are not altered in frequency.

It sometimes causes slight dyspnoea, or breathlessness, with inclination to cough.

A desire to sigh convulsively.

° Asthma, it removes the dyspnoea immediately, and prevents its return.

Heart and Circulation.

• Prcecordial anxiety.

• The beating of thq heart and of the carotids is, in some persons, very marked.

• Accelerated heart-action, with increased frequency of cardiac pulsations.

• Great cardiac oppression and tumultuous heart-action.

• An aching pain and constriction around the heart. (This sensation continued, more or less, for three weeks ; was relieved by taking Cactus.)

It invariably quickens the pulse, but in a variable degree, sometimes doubling its pace.

While the pulse is always increased in frequency, it is not in force. Pulse irregular and jerking.

It relaxes the whole arterial system, probably by partially paralyzing the sympathetic ganglia and motor nerves.

° Angina pectoris , with throbbing of the heart and carotids as high as the ears. Very severe praecordial pain, extending to the right arm. (Dr. Sidney Ringer.)

• Angina pectoris, with great agony. (Drs. Brunton, Anstie, and Talfourd Jones.)

° Very successful in sun-stroke or heat-stroke.

Extremities.

Tired feeling of the limbs.

Tremulousness of the hand, and stiffness and slight numbness of the fingers.

Generalities.

General relaxed, weak feeling all over the whole body.

General sudden perspiration.

She turned deadly pale, felt very giddy, then became partially unconscious, remaining so for ten minutes.

A feeling of increased warmth and perspiration over the whole body, especially the head, face, and neck, while the hands and feet may become very cold, and remain so for many hours.

° A severe burning sensation over the loins, from whence a glow of heat spreads over the whole body, followed by perspiration. This sensation was so unendurable that she would rush to open a window at night, even in the winter, and sometimes rush outdoors. (This symptom had lasted three years, with several attacks daily, and was cured in ten days.) (Dr. Ringer.)