GLONOIN (NITRO-GLYCERINE).
I have elsewhere, in our journals, called attention to Glonoin as superior to all other agents as a stimulant to the failing heart in cases of sudden collapse. It acts quicker than stimulants containing alcohol or ammonia, and, although not so rapid in its action, it is much safer than Amyl Nitrite.
In the collapse which attends pernicious malarial fever, in the syncope which occurs in advanced stages of typhoid, in the threatening heart-failure of pneumonia, and even in the utter prostration of cholera and cholera morbus, it is of inestimable value, for it rescues when Digitalis or Strophanthus has not time to act. In such cases it arouses the failing power of the cardiac ganglia, and prepares the way for the successful use of the above cardiac tonics. It will even prolong life for hours when the fatal end in inevitable.
In doses of one-hundredth or one-fiftieth of a drop the heart responds to its influence in less than fifteen minutes.
This substance, named Glonoin by Hering, is pure Nitro- glycerine. The Homoeopathic school was the first to use it, and its use by Hering was according to the law of similia. The Allopathic school, a few years ago, commenced its use, but in a different manner. After a study of its physiological effects, they began to use it as an antipathic remedy. Both schools employ it successfully in combating many troublesome and even grave disorders. It affords an example of the beneficial effects of a drug used in opposite directions. Those of you who have studied its pathogenesis by Hering and others must have a very clear idea of its effects on the human system. But the pathogenesis cannot be perfectly understood until we study it in the light of modern pathology. Without this light, the symptoms of Glonoin seem to resemble those of a purely vascular stimulant. The heart seems to be excited to unwanted action, and to throw the blood to all the organs of the body, especially the brain, with such energy as to cause active congestion. But the fact is that it does not primarily stimulate the heart by acting directly on it. On the contrary, Glonoin acts primarily and directly upon the vaso-motor centres in the brain. It causes a paralysis of the vaso- constrictor nerves. The result is paralysis of the involuntary muscular tissues in the blood-vessels. This causes a dilatation of the bloodvessels, and an immense increase in the area vasculosa. As soon as the vascular area is largely increased, the demand for blood by the dilated bloodvessels is increased, and the heart is stimulated by the decreased resistance. The result is that the action and power of that organ are enormously increased. In this manner are explained the apparent congestion, the increased action of the heart and the vascular turgescence. The object of this paper is not to give the general therapeutical power of this drug, but to point out the cardiac disorders in which it will prove useful. The first disorder to which I call your attention is
ANGINA PECTORIS.
It seems to have been demonstrated by the researches of Potain, Huchard, Herard and others, that real angina is caused by an ischaemia (narrowing) of the bloodvessels of the heart itself. This narrowing may be caused by a spasm of the vaso-motor constrictor nerves of the myocardium, or an ossification of the coronary arteries. In the latter case, all medicines are powerless. In the former Glonoin, or its sister drug, Amyl Nitrite, are potent remedies. They are not primarily homoeopathic to such a condition, but secondarily so. Even if only physiologically indicated, the fact remains that Glonoin is invaluable as a palliative, and will often snatch the patient from death. By its power of dilating the arterioles, or paralyzing the vaso-motor constrictors, it allows the blood to re-enter the arteries and the terrible heart-pang is relieved. For similar reasons, Glonoin is potent to relieve those cases of cerebral anaemia due to aortic constriction and insufficiency. This cerebral ischaemia causes those sudden faintings, syncopal attacks and so-called heart-failures, which are so dangerous unless promptly relieved. There are cases of terrible
CARDIAC DYSPNOEA, which are promptly relieved by Glonoin. This form of dyspnoea is caused by a constriction of the arteries of the lungs. The heart is powerless to overcome the obstruction, and the patient is in imminent danger suffocation. The proper dose of Glonoin removes in a few minutes this serious condition by dilating the closed bloodvessels.
PALPITATION OF THE HEART
This disturbance of the heart’s action is often caused by vaso- motor constriction. In such cases, the face, hands and other surfaces of the body are cold, and bathed in a cold sweat; meanwhile, the heart is beating rapidly and wildly, vainly striving to throw the blood into the capillaries. If not relieved, the heart often dies – paralyzed in diastole. Here a physiological dose of Glonoin dilates the closed capillaries, the heart is quieted and a great danger averted. But we are not restricted to the above class of cardiac disorders, for we can use Glonoin in many cases when an opposite condition of the arteries occurs, namely, in paralysis of the vaso-constrictors. This is its homoeopathic use. The old school, not believing in the law of similia, consider it contraindicated, and even dangerous, in such cases. So it is in tangible or physiological doses, but not so in minute doses, as the clinical records of our school show.
There are many cases of cerebral congestion due to paresis of the vaso-motor constrictors of the cerebral bloodvessels. They then allow the heart to throw into the brain an undue amount of blood. In young persons this condition is not often dangerous, but in the old who have weak or brittle arteries, it may result in apopletic extravasation. In such cases we find in the third centesimal dilution of Glonoin a specific remedy. Cardiac dilatation, with thinning of the walls of the heart, is another condition to which Glonoin is perfectly homoeopathic. Concomitant to this dilatation there is a lax condition of the coats of the arteries, because the heart is too weak to fill them. In such a state Glonoin alone will palliate, and aid a true cardiac tonic, like Digitalis or Strychnine, to enable the heart to regain its power.
CARDIAC IRRITABILITY.
When this condition is caused by long-continued mental strain, or abuse of alcohol or tobacco, Glonoin has, in my hands, proved one of the most valuable remedies we possess. I have the records of many cases, but owing to lack of time I cannot transcribe them. However, I beg leave to present several cases, similar to my own, reported by Dr. James K. Crook. The doses used by him were the same I have found most useful.
CASE I. – Cardiac Irritability due to the Excessive Use of Tobacco. – T.B., male aet. 71, applied for treatment December 21st, 1886. This patient was formerly an excessive chewer and smoker of tobacco. Ten years ago he suffered severely from attacks of pain over the lower end and to the left of the sternum, together with severe cardiac palpitation. By medical advice he discontinued the use of tobacco, when the trouble gradually subsided. He resumed the tobacco several months ago; within a month the cardiac trouble reappeared, and soon became worse than ever. he then diminished the daily quotum of the weed, but did not abandon it altogether. At this time, he informs me, the attacks came on with unprecedented severity, and he seldom passed an hour without feeling something wrong with his heart. On physical examination this organ was found to be normal in size, but irregular in action, and dropping about two beats to the minute. Patient was ordered to desist from tobacco, and was prescribed one drop of the centesimal alcoholic solution of Nitro-glycerine three times a day. On December 28th, patient informs me that he has found it impossible to relinquish his tobacco, but that he has taken the medicine regularly as prescribed. He expressed great relief; says that for the past two or three nights he has been able to sleep on his left side without inconvenience. The spells are greatly mitigated in severity. On physical examination, also, the heart is found to be more regular and less intermitting than at his previous visit. The patient continued to improve until the middle of January, 1887, when the cardiac trouble has almost completely disappeared, notwithstanding the fact that he persistently declined to abandon the use of tobacco. At that time he disappeared from observation and has not since been seen, so that I am not prepared to say how long the relief continued.
Unfortunately, Glonoin does not always act as well in such cases. I have tried it faithfully in another case of cardiac trouble, plainly due to the effects of tobacco, but with entirely negative results. An account of this case will be introduced here, although considerably out of chronological order.
CASE II. – Cardiac Irritability and Palpitation due to Tobacco. – P.M., aet., 37 came under observation November 17th, 1887. This patient has used tobacco constantly since he was 10 years old. Sometimes he will renew his quid every ten minutes during the day, and also smoke several times daily. For the past eight or nine years he has been troubled with cardiac palpitation. His heart will often become excited and beat with painful rapidity without apparent cause. On examination this organ was found to be normal in size, but rather weak in its action, and beating at the rate of 86 per minute. Patient was advised to desist from the use of tobacco, and was prescribed one drop of the one per cent. solution of Glonoin three times a day. On November 29th the patient reports that he has taken the drug as prescribed with great regularity. He states that he has diminished his daily quantity of tobacco, but was unable to leave it off altogether. There has been no improvement whatever in his symptoms. He says he has had one spell of cardiac distress since his previous visit which eclipsed all others in severity. The medicine always gives him a headache a few minutes after being taken. Ordered Glonoin continued in double doses (gtt. ij, cent. sol., t.i.d.), and again insisted upon the necessity of discarding tobacco.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.