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150 years ago: An indication for nitrite of amyl. Practitioner Oct 2019;263(1830):29

150 years ago: An indication for nitrite of amyl

24 Oct 2019

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Written 150 years ago by Talfourd Jones, M.B. Lond., University Medical Scholar, Physician to the Brecknock County and Borough General Infirmary

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AT TWELVE O’CLOCK ON THE NIGHT of October 23, 1870, a woman begged I would instantly go and see her daughter, who, she said, ‘was in a dying state.’

On entering her bedroom, I saw the patient, a young married woman, half undressed, sitting on the corner of the bed and holding on to the bed-post. There was a dusky leaden hue about her face, neck, chest, and hands, and a cold damp sweat clung to her. Her body generally was cold, but her feet and legs were of an icy coldness. Her pulse could scarcely be felt. She was making violent efforts to breathe, and each inspiration was accompanied with marked recession of the supra-clavicular and the intercostal spaces. Loud sibilant rales with sonorous rhonchus could be heard over the greater part of the chest.  She tried to speak, but could only make faint gasps.

The thought instantly occurred to me that the nitrite of amyl which I had procured only a short while before might be of use. I ran back to my house, which was close by, and returned with the bottle. Five drops of amyl were applied, on a piece of lint, to her nostrils; in half a minute her face began to redden, and in less than a minute it was deeply flushed; her heart palpitated, her carotids throbbed, warmth of body quickly returned, and her breathing became easy.

The effect was marvellous, and I felt nearly as much astonished as the patient and her mother. She now became able to converse. She told me that she had been subject to asthma for many years, that her father also was asthmatical, and that she had never before had such a severe attack as this. She accounted for it thus: in the early part of the day she was as well as usual; but that evening she remained out for some time in the wet, and returned home feeling damp, cold, and chilly.

In about ten minutes after the inhalation, the breathing became a little asthmatical, so we re-applied the amyl, and again she became perfectly easy, and went to bed.  Next morning she told me that she had had a most comfortable night, the asthma had quite gone, and she was attending to her household duties.

About five months after this attack, March 26th, 1871, I  was again summoned to her. This time it was nothing more than an ordinary severe bout of asthma, and wanting the signs of severe collapse that accompanied the first.  A repetition of the amyl treatment was followed by results as speedy and effectual as in the first instance.

Assuming that our theories of the physiological action of nitrite of amyl and the pathological cause of asthma are right, then the explanation of the action of amyl in asthma is easy. The remedies most useful in asthma are those which relax muscular spasm. Nitrite of amyl is a relaxer of muscular spasm, and, as I have shown, is capable of relaxing spasm of the bronchial tubes.

“On entering her bedroom, I saw the patient, a young married woman, half undressed, sitting on the corner of the bed and holding on to the bed-post. There was a dusky leaden hue about her face, neck, chest, and hands, and a cold damp sweat clung to her. Her body generally was cold, but her feet and legs were of an icy coldness”

“Her pulse could scarcely be felt. She was making violent efforts to breathe, and each inspiration was accompanied with marked recession of the supra-clavicular and the intercostal spaces. Loud sibilant rales with sonorous rhonchus could be heard over the greater part of the chest.  She tried to speak, but could only make faint gasps”

 

“The thought instantly occurred to me that the nitrite of amyl which I had procured only a short while before might be of use. I ran back to my house, which was close by, and returned with the bottle. Five drops of amyl were applied, on a piece of lint, to her nostrils; in half a minute her face began to redden, and in less than a minute it was deeply flushed; her heart palpitated, her carotids throbbed, warmth of body quickly returned, and her breathing became easy”

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