be explained by the fact of its being a powerful depressant of the reflex motor centres, which, in this disease, present a condition of exalted functional activity. Amyl has been used, with more or less success, in cases of angina pectoris^), asthma, tetanus (e), facial neuralgia, and other diseases. It was recommended as a remedy in the collapse of cholera by Dr. Chapman in 18G6, and about the same time by Dr. Gamgee. Dr. Talfourd Jones advocates its employment in the British Medical Journal (f) for 30th September 1871. He enunciates the following propositions regarding its action : 1. That the collapse of cholera is the result of an impediment to the circulation of blood through the lungs, and that this impediment is due to the-contraction of the muscular fibres of the minute pulmonary arteries. 2. That the cramps of cholera are due to a like spasm or contraction of voluntary and involuntary muscular fibre iti other parts of the body. 3. That nitrite of amyl possesses the property, when taken into the system, of causing relaxation of muscular spasm and arterial dilatation. 4. That in many features there is a considerable resemblance between cholera collapse and asthmatic collapse. That nitrite of amyl is a remedy capable of giving o. instant relief in asthmatic collapse. Dr. Jones writes somewhat " enthusiastically on this subject, and he ventures to suggest the hope that the physiological antidote to cholera will be found in nitrite of amyl." Dr. T. Lauder Brunton, of St. Bartholomew's Hospital, has, in the British Medical Journal for January 13th, 1872, produced a most interesting paper, in which he pleads for the use of amyl, hypodermically, in cholera. He believes that it relaxes the pulmonary vessels during collapse, allowing a fuller stream of blood to pass into the left ventricle and thence to the system. Drs. Hayden and Cruise gave a fair trial to the inhalation of nitrite of amyl in the collapse of cholera (during the epidemic of 1866 at the Mater Misericordioe Hospital, Dublin). Thry found in one case that " the pulse became perceptible, after inhalation, for a few minutes, and the patient seemed otherwise improvedbut in this, and other cases, the remedy appeared to" aggravate thirst and to interfere with respiration, and it was abandoned on this account. Dr. Arthur Gamgee has shown (Royal Soc. Trans) that the amyl combines with hfemoglobin, the oxygen-carrier of the blood, and prevents it from giving off oxygen after it has taken it up, and that on this account it is liable to produce asphyxia and convulsions; but Professor H. C. Wood, of Philadelphia, " found no convulsions after injecting it sub-cutaneously" (in the case of animals). From these premises, and under the belief that cholera collapse depends upon contraction of the pulmonary capillaries (.and partly npon a thickened condition of the blood), Dr. Brunton suggested that nitrite of amyl" might with advantage be used hypodermically in cholera, so as to relax the capillaries, without at the same time injuriously impairing the respiratory changes in the blood and tissues." The above notes are therefore interesting as being descriptiva of a case in which this remedy was carefully and fairly tried in the manner suggested. From the above table it will be seen that, in the present case, the amyl had no very marked effect on the pulse. After each injection the brachial pulse was perhaps a little broader than before, but even this effect was insignificant and very transient. Respiration was on tiie whole slightly accelerated. The temperature rose two degrees during the operation; but at last it sank nearly one degree. The general condition of the patient could not be said to have improved in any way. Altogether two drachms of the amyl were administered in one hour and 36 minutes. The patient died about two hours and a half after the operation. Towards the termination of the injecting process the patient became slightly more restless than before, but nothing like convulsions occurred. He complained of no difficulty in breathing, nor of increased tnirst. My main object in publishing this case is to show that (so far as it goes, and taken by itself) it seems to afford evidence to the opinions which have been founded on contrary theoretical grounds as to the power of amyl to counteract cholera collapse by relieving arterial spasm. The remedy had a very careful and fair trial, and the effects, which were closely watched, to

A MIRROR. OF HOSPITAL

PRACTICE.

MEDICAL COLLEGE HOSPITAL. A CASE OF CIICLERA TREATED BY HYPODERMIC INJECTION OF NITRITE OF AMYL.

By

David B.

Smith,

M.D.

M. L. B., a Bengali, ageil '.'5, moderately strong and wellmade, was brought into the Medical College Hospital, in a state of deep cholera collapse, on the 30tli January 1873. at 9 p.m. He had been suffering from purging and vomiting, with cramps, for two days. On admission there was no pulse at the radials. The brachials were only faintly perceptible. The temperature in the axilla was 93-4?F. ; respirations 26 ; voice He was ordered calomel in large doses, but vi ry feeble. continued much in the same state till 11 a.m. next day. It was then decided to try the hypodermic injection of amvl. The preparation used was manufactured by Messrs. Duncan and Flockart. of Edinburgh. It was kindly given to me by Dr. A. Cronibie, Resident Surgeon of the Medical College Hospital, to whom I am much indebted for the trouble he took in watching Avith me the effects of the retnedy in the present case. The was 11 at The commenced a.m. operation following table shows the results of the proceeding, which extended over an hour and a half: No. of

injections

and quantity

Femoral

injected, pulse.

a.m. 1st.?10 minims, at 11 at 11-5 a.m. 2nd.?10 ? at 11-18 a.m. 3rd.? 5 ? at 11-23 a.m. 4ih.? 5 ? 11-30 a.m. at 5 5th.? ? at 11-36 a.m. 6tli.? 5 ? at 11-46 a.m. Itli.?10 ? at 12 noon 8tfi.?10 ? at 12-5 pm. 9th.?15 ? at 12-10 10th.? 5 ? p.m. Wtli.?10 at 12-17 p.m. ? at 12-21 p.m. 12th.?10 ? at 12-33 p.m. 13th.?10 ? at 12-36 p.m. 14th.?10 ?

Inspira- Tempertions.

92 98 96 102 98 98 96 98 96 96 102 100

34 35 36 38 38 37 38 40 38 38 40 36

92

36

ature.

93

F.

93?F.

95?F. 95? F. 95?F. 95?F. 95?F. 95?F. 94-PF.

Remarks.?The physiological effects of nitrite of amyl (which \> as first discovered by M. lialard) were investigated by Frederick Guthrie in 1359.(a) The general effects of the remedy, as determined by Dr. Brunton's physiological researches, conducted in Professor Ludwig's laborato'rv, and published in the Leipzig Transactions, are described as follows (Rabbits were experimented on, and the amyl was given by inhalation) : 1. The effect of nitrite of amyl is to diminish arterial pressure. 2. It does not diminish the work done by_ the heart in a given time, although it increases the frequency of its contractions. ?

3. It does not exercise its influence on the nervous system, but the contracted walls of the blood-vessels, reducing the arterial pressure by diminishing the resistance to the circulation. (6) Dr. II. C. Wood, of Philadelphia, believes (c) that its action is sedative and not stimulant, and that it, eatalytically, arrests oxidation. He believes that its favorable action in tetanus is

on

(d) Vide Medical Times and Gazette, March 19th, 1870; The Lancet, I., 18(57, p. 97; Glasgow .Medical Journal, August 1869 ; Edinburgh Medical Journal, July 187u and Medical Times and Gazette, Aug. Oth, 1870. (c) Vide Lancet, April 9th, 1870, and vol. I, 1871, p. 572. " (J) And iu the Practitioner" for October 1871.

vol.

Journal of the Clinical Soc:et.y, vol. XI., p. 215. (J) Medicnl Times and Gazette, September 3rd, 1870. (o) The American Journal of Aledical Sciences, Oct. 1S71, p. 359,

(a)

Vide

124,

THE INDIAN MEDICAL GAZETTE.

accurately recorded above. It caused no unfavorable symp(except slight increase of restlessness at last), but it certainly could not be said to have produced any beneficial effect are

toms

whatever.

[Mat

1, 1S73.