antimony are important for us, above all the potassium antimony tartrate, a double salt of tartaric acid. Tartarus stibiatus and tartarus emeticus, are other names for the same preparation. The other common antimony preparations are the naturally appearing sulphur compounds Sb2 S3 black or grey antimony our antimonium crudum and Sb2S5, red antimonium sulphide, our antimon, sulfurat, aurantiacum. Antimonium aresenicosum is a mixture of antimony pentoxide Sb2O5, with arsenic trioxide, As2O3. The variability of these preparations constitutes a great difficulty in deminitely establishing the characteristic antimony effect. In general potassium antimony tartrate is regarded as the compound which comes the nearest to approximating a true antimony effect, since the antimony binding here is very loose. Experimental investigations have also been made largely with it. Spiro assumes that the slighterobserved favorable effects from these.
This group is named after the first member of its group, nitrogen, but as in all chief groups, here the elements with the lowest ordinal number is the least characteristic of the group, because, as an element, nitrogen, in contrast to phosphorus and arsenic, is quite inert and its H as well as O compounds differ considerably from the other elements of the group. The H compounds of nitrogen, ammonia and its salts, do not come into consideration in comparison as drugs with the usual compounds of the other elements of this group, and they have already been discussed with the alkalies. The remaining elements of group V unfold their actions in or on the organism, especially in the various stages of oxidation. And if one compares the already oxidized compounds of nitrogen with the usual compounds of phosphorus and arsenic which are employed as drugs, then the group relationships will become more distinct. The actions on the vascular system, in particular on the capillaries, which give the essential note to the members of this group, naturally vary considerably in degree. And with the increase of metallic character of the elements with increasing atomic weight, the action sphere in this group narrows itself evermore in an organotropic sense. Nevertheless in the transition of medicinal preparations in the series from nitrogen, N, to phosphorus, P, Arsenic, AS, antimony or stibium, Sb, to bismuth, Bi, the red line can be easily followed which also traces out the group affinities of these elements.
NITRITES AND NITRATES
The point of departure in a pharmacologic consideration of nitrites and nitrates is the action on the vessels and blood pressure. It is not only the NO2 or better O. NO anion, the inorganic salts and organic esters of nitrous acid, but also a number of organic esters of nitric acid, as nitroglycerin, whose manner of action is characteristic. Also the inorganic nitrates, potassium and sodium nitrate, still work in the same sense so that one might assume a reduction to nitrites in the organism. Such a reduction by micro-organisms have the capacity for obtaining oxygen out of nitrates; the plants use nitrates for the building of protein, NH2 compounds, and here also a reduction must occur. It is important that the pharmacologic action of nitrates or nitrites appears only in the true salts or esters, that is, the nitrogen as an alkali metal or an organic radical through the intermediation of oxygen; in other words it must be inorganically bound; moreover, it must be as O. NO. In the nitro-bodies in which the nitrogens is bound directly, that is organically to the radical, the characteristic action is practically absent.
Best investigated experimentally of the nitrites is amyl nitrite; of the nitrates, nitroglycerin, the glonoin, of the homoeopathic materia medica. Even if amyl nitrite C5H11.O.N.O
is used only a little in homoeopathy, still one approaches nitrite action advantageously from it, because, it has been studied the best.
The transient alleviation which amyl nitrite as well as nitroglycerin gives in angina pectoris through widening of the coronary vessels is generally known. For homoeopathy it
is interesting as the first fact that the inhalation of vapors of only a few drops of amyl nitrite can produce very definite symptoms. The amount, certainly very slight, becomes effective with the mucous membranes of the respiratory organs acting as the portal of entry, and it is indeed exactly the great dispersion which favors this. The possibility that, by fine division, still other materials could be effective in this way, Hahnemann’s olfaction of the high potency, is not rejected without further consideration.
The second fact of decided interest is the particular relation of nitrites to the upper part of the body. If we find so frequently in homoeopathic literature reports acts from above down or from left to right then at first this seems absurd, but observation teaches it and requires explanation. And one so observed selection of a body region that appears free from objection occurs with amyl nitrite.
The immediate action on inspiration of the vapors of a few drops of amyl nitrite is the feeling of warmth in the head and neck, usually, a feeling of fullness and heaviness of the head; the arteries pulsate, vertigo and severe headache often appear. Face, head and neck are reddened; usually this reddening is limited to the head, neck and chest; only rarely does it reach the back or extend to the arms. The lower extremities are not involved in the widening of the blood vessels. The pulse becomes distinctly accelerated, often irregular. It is striking that in other cases the previously irregular pulse becomes regular. Therein one sees that a reversal of symptomatic effect of drug action can also lie simply in the diversity of the conditions, in the previously balanced or imbalanced state of the organism, and that it is not always the difference in dose which is responsible for such a reversal of the end result.
Severe toxic manifestations are represented by a type of intoxication with loquacity, at times nausea and vomiting, fainting and collapse; moreover, one will observe after marked and longer inhalations, indistinct vision or yellow vision, muscle twitching, local or general outbreak of sweat. According to pick, after a full dose of amyl nitrite objects appeared of a yellow color with a blue-violet halo surrounded with wavy borders.
The blood-vessel actions of the nitrites are the most important. They manifest themselves in widening of definite vascular fields, rapid sinking of the systolic and diastolic blood pressure, and acceleration of the pulse. The action occurs very rapidly (in a few seconds) after the inhalation, but has soon disappeared (after a few minutes). In men of middle age the action is more marked than in the very young and very old.
The fall in blood pressure, according to experimental results, is certainly to be ascribed to blood-vessel widening and not to an action upon the heart. An action immediately upon the vessels is established, but, in spite of a large number of refined pharmacologic experiments, it is still debated (between Brunton and others on the one side and Filehne on the other side whether the action of nitrites on the vessel is purely peripheral or also partly conditioned through central depression of the vasoconstrictors. For the participation of the centrum speaks an observation of Darwin that under nitrites exactly those parts are reddened which are also reddened by the feeling of shame a therapeutic indication, perhaps, for this symptom, if it is annoying through an excess. The numerous animal experiments, on the contrary, speak for a pure peripheral action on the vessel wall.
That many questions remained unsolved in this respect is shown by animal experiment when after compression of the carotid amyl nitrites is injected into the cranial end (the amyl nitrite in salt solution), it thereby effects an increase in blood pressure. Whether the peripheral-vessel action is excreted on the musculature or upon the nerve endings lying in it is still not determined.
Besides the ever again demonstrated vessel widening, the old observation of Gaspeys serve to show that bleeding from injured arteries begins again when amyl nitrite is administered. According to Lisin a wound of the intestine or the lip would bleed less by virtue of the lowering of blood pressure, but when the pressure returned to normal, the bleeding would be greater than before.
According to experiments of D.L. Brunton, the acceleration of cardiac action depends upon lessened activity of the vagus center; according to Dossin, however, also upon stimulation of the nervi accelerantes. In any case this action, at least partly, is the result of fall of pressure as in anemia and also an attempt at balance. As the tonus of the vagus center is greater during middle age, so the acceleration of the pulse in middle life is more marked in comparison to youth and to old age. But by single authors a direct action upon the heart is assured outside of central effects. Moreover, by inhalation of amyl nitrite a slowing of the heart is also observed through a reflex action on the respiratory passage. Outside of the acceleration of rhythm, still further proof of increased activity of the heart can be observed, as for example increased capacity of conduction and heightened contractility. The final weakening and paresis of the mammalian heart through enormous amounts can as well be a direct action as a result of asphyxia in consequence to alteration of the blood (methemoglobin formation). (The influence on respiration consists of irregularity at first after inhalation, this being a reflex irritant effect, also mild slowing, at the beginning: but on repeated inhalation, stronger acceleration follows the initial slowing, perhaps as action upon the vagus endings or upon the respiratory center, the acceleration like the cardiac increase probably being a compensatory attempt in consequence to the low blood pressure).