Ammonium muriaticum

Volume I — Main text

AMMONIUM MURIATICUM.

Sal ammoniac, Ammonic chloride, NH^Cl.

I, Pri^vingi. — I, Hahkemann, Chronic Diseases^ Part II of original. Vol. of translation. Contains 397 symptoms from self and three fellow-observers,

1. — a. Dr. GiTMPERT commenced* by administering 5SS or 5J in 24h., increasing doses by 3J every 3 or 4 d.^ until 31 v — ^vj were taken daily. When about half a pound had been used in the course of 4 weeks, the following complex of symptoms would appear : — There was a state of things exactly resembling a status pituitosus, attended with the most invincible repugnance to the remedy, so that even the thought of it would cause nausea. The eyes became dull, and presented a peculiar glassy or watery shine ; lassitude, sluggishness and prostration overpowered whole body ; tongue became coated white ; patient experienced a constant shivering, horripilation between skin and flesh \ he hawked constantly and cleared his throat because there was an inces* sant tickling there, although he did not get up much mucus ; there was sense of emptiness in stomach, but he could not bring himself to take food. Perspiration was generally increased j sweat broke out

• Gum pert 's subjects were seven patients, one with adiposis, the second with iw>me urinary catarrh, the other five witfi maladies unmcntioncd. As the symptoms were unitarm in all, we have fch justified in inserting them as pathogenetic ^m the

from slightest movement. Much urine was excreted, of a strong ammoniacal or even mouldy odour, though generally quite clean Glassy and viscid mucus* was occasionally evacuated by stool, but diarrhoea occurred only rarely.

b. This state of things did not last long before a formal attack of fever would prostrate patient upon his bed. The paroxysm commenced with chill and heat, and ended with profuse perspiration. It resembled that of an ordinary intermittent, and was followed by relief from the premonitory symptoms recorded above, and from some of those of the disease for which it was given. In the course of 18 months G, has observed five cases of the kind, all of which followed the seven-day type quite accurately : the paroxysms recurred regularly as long as the organism was sufficiently saturated with the salt ; ceased or became slighter as the saturation decreased, and could be reproduced at pleasure by resuming remedy. In one case the febris septimana set in after sal ammoniac had been taken 6 weeks, and recurred every Thursday for 4 weeks : 5th paroxysm w,is slight, and the 6ch omitted, but a 7th occurred on fresh dosing with the drug. [This was the patient with adiposis : he was much benefited by the treatment.] {Med, Ztg, vom Ferein f, Heiik. in Preussen, vii, 179.)

1. Dr. Rabuteau took 2\ grm, twice daily for 5 d. For 5 d. previously urine showed average of 1027 grm. and urea oi 21 '40, for 5 d. subsequently average was 1078 and 2162 respectively ; while during medication it was 1343 for urine and 2441 for urea.f The secretion also, ordinarily clear, was on these days turbid with urates on cooling. He did not take his temperature, but it seemed to him elevated, — his hands being nearly always hot, — and his pulse averaged 66 instead of 618 and 6 r2 (the figures before and after medication). There was no diaphoresis, neither did digestive or nervous disturbance occur {UUnhn Mid.y 1871, ii, 330,)

2. WiBMER, on Aug, 1 8th, took at 12.30 gr. v in water without effect. On 19th, pulse 68, took gr. x at 7 and again at 8 a.m. Between 9 and 10 increased call to urinate, warmth in stomach, mouth and fauces very moist, loose cough. At noon a stool, softer than usual. At 12.30, pulse 73, took gr, xv. After J h. warmth and discomfort in stomach, some headache in temples and forehead for 10 — 15 m. only. At 2 ate with appetite. At 5,45 gr. xx. In J h.

hagain warmth and weight in stomach, headache in forehead, thinking [jwer unaffected. In i h, increased secretion of urine. Ate supper with appetite. On aoth quite well save for pressure in stomach for a few m, and slight nausea. {IVirkung dtr Ari.n, w. G., sub voce.)

1. — a. Increase in excretion of urine seems to be a constant effect of sal ammoniac administered internally. Bocker always found in experiments on himself that he excreted from 250 — 600 grm, more under these circumstances*

• ** Of these effects, the increased secretion of mucus ha* been confinncd by all other obscr^'ers; it seems therefore to be well founded" (Not H nag EL and Rossbach).

f "According to the recent researches of Knicricm \Zeitsch,j. EioUgit^ '7S)» the major |iajt of the ammonia taken into the system is transformed mio urea, in which form it appears in the urine' (Boehm, in Ziemssca's Cychpadia, xvii, 357).

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h. According to Bocker the absolute quantity of the expired carbonic is considerably increased at the outset, while the percentage in the expired air is slightly diminished. After long-continued use both absolue and relative amounts are very much lessened. (Nothnacel and RossBACHj &p. at,)

1. — a, Sundelin says that in large doses it purges like other salts, but in small ones rather constipates.

h, Kraus says that a slight miliary eruption and very painful aphthae have been produced by large doses of it. (Pi-RErRA, op. cit,)

7* RfiCHNiTz gave sal ammoniac to a patient suffering from some injury and from a perinseal fistula, commencing with 3SS and going to 5j pifK dUm, Soon there occurred such disgust at the remedy that he could not even look at the drawer where it was kept without vomiting* He had prostration and weakness of limbs j violent boring parns in lower extremities j drawing in jaws ; pulse quick, small, soft i tongue white-furred -, thirst great ; neither stool nor urine increased ; frequent vomiting of green fluid. No intermitting fever noticed, {Med, Jahr. diT k. k. (Est. St,^ xxxi, 224.)

1. Fischer gave to a man with enlarged prostate 3ij of amm. mur. every 1 h. After 3 weeks of this treatment patient reported that he had a severe miliary fever [Frtesel). ** This Friael^*^ Rechnitz writes, ^ is well known to me : it never fails to appear during prolonged use of large doses of sal ammoniac." [Caspers IVochemchrifty ^^ZZ\ p. 820.)

9* 3rd March. — Of 5iij amm* m. in Jvij water, took at 8, 9, 10, 1 1> J 2 a.m,, 2»35, 3.10, 3.40, 2 tablcspoonfuls, at 4.5p.m. I tablespoonful j of \ oz* in 8 oz. water, at 6 p.m. I tablespoonful, 11.10 p.m., 2 tablcspoonfuls. No symptoms. — 4th. Of last solution, at 6.45, 7,30, 8.5, 9.10, 10, II, 12 a.m. 2 tablcspoonfuls* — sth. \ 02. amm. m. in 6 oz. of water. At 8, 10, 11, 12 a.m., 3.40, 4 p.m., 2 tablespoonfuls, ^oz. amm. m. in 8 oz. of water. At 5, i tablespoonful ; at 5.30, 6.35, u p.m. 2 tablcspoonfuls. At 6 a.m. some pinching in belly below navel. On rising from bed pappy taste. At 10.30 a m., expectoration of mucus from throat and slight nausea. Afternoon and e. easy expectoration of mucus. — ^6th. At 7.45, 9.40, 10.40, 11,25 a.m., 12 noon, 4, 7.35 p.m,, 2 tablespoonfuls, 11.15 p.m., 3 tablespoonfuls. Diminished appetite. At 6 p.m. pinching in abdomen below navel, soon passing off. 8 p.m., feeling of roughness in chest, inclination to breathe deeply, and cough with scanty mucous expectoration. Sleep restless, twice awoke by noise but soon fell asleep. On rising in m. a pappy taste, furred tongue, and little appetite. — 7th. At 7.30, 9, 10.5, II, 11.3.5 a.m., 4.30, 10.30 pm J ^ tablcspoonfuls. During d. coughing and hawking of mucus. On rising in m., tongue more furred, little appetite for breakfast. 10 a.m. Tongue clean, occasional expectoration of mucus. At il a.m. repealed expectoration of mucus. 2.45 p.m. Hard stool covered with mucus. Afternoon, coughed and hawked mucus. Feeling of fulness in abdomen. — 8th. On waking, I. nostril stopped up with mucus, removed by sneezing. On blowing nose some drops of brownish blood mixed with mucus. — 8th. i oz* amm. m« in 6 oz, water. At 8 a«m., j tablcspoonfuls, 9,

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10.10 a«m. 2 tablespoonfuls, ii a.m. 3 tablespoonfuls^ 12 noon 2 tablespoonfuls, 3.30 p,m, 2 tablespoon fu Is, 9 p,m» 2 tablespoonfuls* On rising in m. tongue slightly furred, appetite diminished* M,, felt weak and expectorated mucus frequently, also afternoon and e» At 12.30 p.m. copious normal stool, f^ccs enveloped in mucus, but compact. Afternoon, frequent discomfort in belly, especially below r. and 1. of navel. All afternoon from 3.30 p.m. onwards, uncomfortable fulness in abdomen lasting till bedtime. E., very tired but not sleepy. At 10.45 ^^^^ 3s ^^ ^^^ bowels twisted about. At 9 p.m., on taking the last dose, extreme Joathing. — ^Qth. ^ oz. amm. m. in 8 oz. water. At 8.16, 9.20, lo.io, II, 11.50 a.m,, 2.30, 3.55, 4.45 p.m* 2 tablespoonfuls, 5.45 p.m., 3 tablespoon fuls. Diminished appetite and disgust at medicine* Stool first firm, then soft. Coughed up some mucus. — 1 0th. 3iij amm. mur, in 5 oz. water. At 8,10, 10 a.m., 3.30, 6.30, 1 1 .45 p.m. 2 tablespoon fuls. On rising in m., tongue cleaner than usual. 9.45 a.m. copious soft stool, expectorated a little mucus. ^ iith. i oz. amm. m. in 5 oz, of water* 8.20, 10, 10,35, 11.15, J 1.45 a.m., 3.20 p.m 2 tablespoonfuls, 4.10 p.m. 3 tablespoon fuls. On washing face m. some bleeding from nose. Sneezed before breakfast. After rising, tilt 9 a.m., expectorated thick phlegm, also a little during d. No stool. During the proving the salts in urine were slightly diminished. The nitrogenous constituents of the urine were increased except the urates, which were diminished. (Boeckbr, Beitragt %ur Heilk.^ ir, 150.)

II. Poisoning, — 1. a. H, W — , a man» set* 25^ convalescent from an attack of acute mania, was taken suddenly ill, at 11 p.m*, on Jan. 22nd, 1868, with sickness, pain in the bowels, instantaneous delirium, fancying enemies were hiding under his bed and accosting him i that a sword was hanging over his head ; and that flames were surrounding him. He then had a convulsive paroxysm, which lasted a few minutes, leaving the hands firmly flexed upon the forearms. The pupils were normal, pulse feeble, 100 ; skin cold and moist, the extremities of a bluish tinge ; eyes tremulous ; with sobbing respiration as of hysteria. After general stimulation, mental tranquillity returned, he was free from pain and began to talk, saying that he had taken poison in large quantity in the afternoon. This was subsequently proved to be chloride of ammonium, but how much had been taken coiild not be ascertained. Patient stated that he felt no inconvenience on first taking it, but in the evening he felt giddy, as if half drunk, staggered, had pain in his stomach, singing in his ears and sensation of dazzling before his eyes.

^. Patient recovered during the n., and at 6 a.m. insisted on getting up, but had so much shivering, thirst, faintness, and giddiness, that he was obliged to return to bed and have some warm drink. At 7 a.m. an attendant, who had left the ward, returned and found the man, as he thought, dead. Breathing had ceased, the jaw dropped, the face was of an ashy paleness, the eyes were open and ciuU, looked filmy, the pupils dilated and insensible to light, no response was made to pricking, pinching, or shaking j the muscles were relaxed and flaccid, the extremities cold, trunk cool f a faint beat of the pulse was felt at the wrist.

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Prompt general stimulation with electricity was resorted to for several in,, when there occurred a shorty broken, gasping respiration, with a tetanic action of the muscles. Then there was agitation with stiffness and rigidity of the muscles of the thorax and arms, which increased and spread to complete opisthotonos. This lasted i m., was followed by relaxation, and a return of the spasm. In } h. a feeble irregular respiration was fully established, sensibility gradually returned, and patient began to cry out, at first faintly and afterwards stronger. In 15 m. more, consciousness partially returned and patient began to look wildly about him, and to resist the treatment. The mental powers returned rapidly, respiration became deeper, the heart's action stronger^ and the surface of the body warmer. In an h. from the commenccrmcnt of the treatment patient had delusions that he had committed murder, that he was suffering the pains of purgatory, that his bowels were on fire, and he cried out lustily. On attempting to rise from bed the muscular system was still powerless ; he could not pass water, and three pints of pale urine were drawn off. Throughout the d. there was considerable drowsiness, with paroxysms of delirious excitement, much pain in the bowels, and a copious evacuation of dark bilious matter of thin consistence {a purgative had been given). Towards c, the pulse became full, bounding, 120, the head hot, conjunctiva engorged, pupils somewhat contracted, temp. 97 '4°. With this reaction the mind cleared up and patient recovered in the course of the next d« (Crichton Browne, Lancet^ 1868, I, 720,)

III. ExpiTtmints on animals. — I. — a* The study of the phenomena which ensue after the absorption of poisonous quantities of ammonium compounds establishes beyond question that all the salts of this base exert the same action — varying only in intensity — on the organs of the nervous system and of the circulation. Langc and the writer have proved experimentally that even ammonium chloride does not, as some authors assume, form an exception to this rule i on the contrary, it is distinguished by an especially energetic action on the nerves.

A, After the administration of the chloride^ the action upon the blood-pressure is more prominent than that upon the respiration, though the latter is sufficiently marked. (Boehm, op. citj)

1. — a, Sal ammoniac has a much milder local effect^ and is much more poisonous when injected into the blood, than ammonia and the carbonate.

b. Mitscherlich, who observed the mucous secretions of the stomach and intestines in rabbits that were fed with sal ammoniac, and found them increased in quantity, says that the epithelium was softer and [ composed of fewer large cells ; the swollen cylindrical cells separated from one another with the slightest motion, became admixed with the mucus in large numbers, and were soon dissolved in it. (Nothnagel and RosSBACH, sub voce,)

1. — a* Causten, Sprogel, Viborg, and Gaspard injected solutions ot sal ammoniac into the veins of dogs and horses ; large doses generally caused convulsions, sometimes paralysis, and death.

b* From the observations of Orfila, Smith, Arnold, and Moiroud, the salt appears to be a local irritant > and, when introduced into the

stomach in large quantities, causes vomiting, purging, and gastroenteritis* It exercises a specific influence over distant organs ; for the first three of the above-mentioned experimenters observed that inflammation of the stomach ensued, to whatever part of the body the salt was applied.

r. Arnold says it diminishes the plasticity of the blood. (Pereira, 9p. cit.)