My attention was drawn to this new remedy by reading in the Medical Times and Gazette of Sept 3, 1870, an editorial on ‘The Progress of Therapeutical Science’. It gave the results of Dr Richardson’s experiments with nitrite of amyl, and described a case of Dr Brunton’s, in which the remedy had been most successfully employed in angina pectoris; also one of Dr Anstie’s, in which it had given marked relief to an asthmatic gentleman who suffered from angina.

Happening to have under my care a most distressing case of angina in an elderly lady, I sent for the nitrite; but the day before it arrived my patient died. I could not afford her that relief from pain which my subsequent use of the remedy tells me she would certainly have had.

Shortly after, October 23, I had an opportunity of trying it in a severe case of spasmodic asthma; and the immediate and almost magical relief it afforded convinced me that in nitrite of amyl we have a most powerful and valuable medicinal agent.

Yet, during the last twelve months I have met with no recorded cases of its employment in disease. While in London a few weeks ago, I made inquiries at two metropolitan hospitals, and found, to my surprise, that in neither had nitrite of amyl been tried. I must, therefore, come to the conclusion that this remedy is most insufficiently known.

I have now given it experimentally to some fifty friends and patients. The pulse is the first tell-tale of its effects: after eight to twelve seconds its frequency rapidly increases. A pulse of twenty in the quarter-minute will often rise in ten or fifteen seconds to forty. The beating of the heart and carotids is in some persons very marked. The reddening of the face sets in later; it usually takes from thirty to forty seconds before there is much flushing. It sometimes causes a little breathlessness and coughing. Now and then it gives rise to giddiness; and, in some, to a feeling of intoxication. Girls often complained that it has given them a headache.

The best and safest administration method is by inhalation.

I usually pour five drops on a piece of lint the size of a crown-piece, or larger, and hold it close to the nostrils for ten or twenty seconds, or until I feel an acceleration of the pulse or see the face beginning to redden; or the nitrite may be dropped onto a pocket-handkerchief, and then held to the nose just like chloroform; or, lastly, it may be inhaled directly from the bottle.

I have never seen any bad effect result from its use. However, judgement and caution should be exercised in its employment in the aged or in persons the subject of arterial degeneration.

I have used nitrite of amyl in cases of spasmodic asthma, angina pectoris, syncope, cardiac dyspnoea, colic and enteralgia.

Case of cardiac dyspnoea

Mrs T. T…………… suffered from dilated hypertrophy of both ventricles, the dilation being in excess, accompanied by a very feeble circulation, and anasarca to an extreme degree extending upwards to the abdomen, slight pulmonary oedema, some lividity of face, but not much shortness of breath.

Hydragogue cathartics and infusion of digitalis, acupuncturation and vapour-baths were used, with temporary relief. The digitalis, given in full and frequently repeated doses at intervals of a week, had invariably induced a copious discharge of urine, but at last its diuretic effects seemed to fail. One day I thought I would see whether cupping the renal region would be of service. During the preceding week she had been inhaling the nitrite of amyl, five drops at a time, four or five times a day, with some relief to her breathing. On each occasion she felt easier, more comfortable about the chest and experienced a pleasant glow all over her body for about an hour.

I proceeded one evening to cup the loins. Two glasses were applied, one over each kidney. The blood flowed slowly, and when there was about a wine glass full in each glass it ceased to run. At that moment it occurred to me that it would be interesting to watch just then the effects of nitrite of amyl upon her.

I applied ten drops on some lint to her nostrils. Soon the radial pulse throbbed, then the face became flushed, and at the same instant blood flowed freely into the cupping-glasses. The experiment was most striking, and clearly showed the influence of amyl on the circulation.