NOTES ON PHENACETIN IN THE TREAT MENT OF CONTINUOUS AND MALARIOUS FEVERS AND ON SULPHONAL AS AN HYPNOTIC. By Surgeon Alex. S. FAULKNER, I. M. S., Bombay Army. Pfienacetin.?The discovery and introduction of this drug is of recent date, and its use in practice lias not yet, as it deserves, become
general. Physical Properties?Are as follows : a white crystalline powder, free from odour and taste,
it melts at a temperature of 135?c, is not soluble in cold water but is dissolved to a certain extent in hot water, but most readily in alcohol. Discovery.?Tt was originally prepared in 1886 by Dr. O. Hinsberg, and in the subsequent year satisfactory results were obtained by Professor Bemberger, whose experiments were published by Dr. Kobler?* In France, M. Lepine made public his experiments about the same time as Dr. Dujardin-Beaumetz, whose paper " On the Phenacetins," was read at the Meeting of the British Medical Association held at Glasgow in August, 1888. In the same year Drs. Misrachi and Refat published an important paper on the subjectf which was read before the Society of Medicine of Salonica. Therapeutic Properties.?It is in a marked degree an antipyretic and its anti-thermic action on the system is of longer duration than is the case after the administration of other antipyretics. In most cases under my observation, it had a diaphoretic action aud caused copious sweating, but in 110 case have I noticed any toxic phenomena attributable to the drug itself. It also has a sedative effect when given in cases of neuralgia, either cranial or facial, sciatica, &c., uncomplicated with a high temperature, and it is stated to have a beneficial effect iu the cases when given in doses commencing with 8 grains, but in prescribing this drug for such cases, it is necessary to bear in mind the results of the researches of Drs. Misrachi and Refat who found that Phenacetin was soluble in Lactic Acid at a temperature of 33*c and this fact, apparently would account for its rapid absorption when administered, since Lactic Acid is usually present in the stomach, so possibly in those cases in which Phenacetin fails to give relief, the failure may be due to the absence of that acid in the stomach, and the indication then naturally would be the addition of a little Lactic Acul. The French observer, M. Lepine, states that Phenacetin affects the blood less than antipyrin or antifebrin, and that doses of even 60 Wiener Med. Wochenschr. 1887?26 and 27. a, l'efcude de la Phenacetine?Bull Gen de Therap, tome LXIV, p. 481?1S88. *
f Coutrib
228
THE INDIAN MEDICAL GAZETTE.
do not effect the heart or cause cyanosis. In the few cases quoted below which I have taken at random, it will be seen that Phenacetin was given in continuous and intermittent fevers of malarial or climatic origin, in pneumonia, rheumatism, neuralgia, &c. Referring to the temperature charts of the fever and acute cases, the anti-thermic actiou of the drug will be seen to be very marked, but of its anti-neuralgic action I cannot, so far, speak definitely. From my observations on this drug, I must assign another important therapeutic quality to Phenacetin, which, apparently, has not previously been observed, and that is, its decided diaphoretic action when given in cases with a high temperature. In comparing Phenacetin with other antipyretics iu the treatment of malarious or continuous fevers, it has a decided advantage, for in all these cases it was administered whilst the fever was actually at its highest., and its effects were to cause diaphoresis and a lowering of the temperature, whereas in the cases treated by antipyrin, quinine, &c., these drugs are given only in the intermissions of fever, and usually simple diaphoretics are administered whilst the fever exists?hence I consider Phenacetin is indicated in preference in the treatment of these cases.
grains
Epitome of
cases.
[Aug.,
1889.
of this
ing
drug, aucl its permanent effects in reductemperature?copious perspiration was
caused in this
case after its administration. Case 3.?Drummer Buston : cetat 30 : service 12 years: was admitted on June 9tli last, suffering from rheumatism and painful joints ; both knees being swollen, hot and acutely painful. At 4 p.m. on the 3rd day after admission his temperature was 100-8, when he Imd a dose of Phenacetin with the following result:?
At '4 p.m. ? 6 p.m. 8 p.m. ?
This
100-8 Pulse 106 Respirations 26 98 100-2 26 ? ? 84 98-6 22 ? ?
Temperature ? ?
to perspire copiously about 6 p.m., and stated his joints were less painful, and no ill-effects of the drug were noticed, and he had no vomiting, headache, &c. At bed-time he had a dose of Sulphonal grs. xx, and slept well till the morning. Next morning his tem? perature was 100 6, when he again had another dose of Phenacetin which reduced the temperaHe slept well after a dose of Sulture to 99'2. phonal that night, and subsequently he did not have any fever, and was ordered Mistura Potassii Iodidi ter in die, and locally iodine application to his joints which were bandaged by flannel bandages over cotton wool. On the 16th instant he was well enough to leave hospital, and
patient began
o
proceeded
on
furlough.
Case 1.?Private Saleek, age 19 years : service 2 years: was admitted into hospital on the He had a 31st of May last suffering from ague. of 103? and was on admission, temperature ordered diaphoretics with cinchona alkaloid in His temperathe intermissions of the fever. ture, however, never fell below 100?. On the 5th of June his temperature rose to 104?, and he was ordered Phenacetin grains viii and another like dose an hour subsequently ; his temperature having fallen in this hour to 103*6. Next morning his temperature was normal, but it again rose to 102*6 in the evening, when he again had another dose of this drug, and his temperature again fell. Subsequently he had little or no fever to speak of, but being debilitated tonics were ordered, and he was discharged well from the hospital on the 16th instant. In this case sulphonal was also administered in xv a grain dose as a hypnotic with good
Case 4.?Lance Naik Ramchunder Ranav : cetat 26 years : service 8 years : stated on admission that he had been suffering from fever for the past two days. On admission (June 14th last) his temperature was 102*6, and he was at once ordered Phenacetin grs. viii with the following result, viz:?
Case 2.?Private Beni Aheer : cetat 19 years : service 1 year: came to hospital on June 1st last suffering from fever. This patient had more or less continuous fever for the first four days in hospital, his temperature ranging from 99? to 103?. This maximum of temperature was reached about midday on the 5th instant, when he was ordered Phenacetin grs. viii. In an hour the temperature was reduced to 101?, and gradually fell to normal, and since that date the patient had no recurrence of fever at all. This case markedly proves the antipyretic action
double
results.
8 9 11 4
A.M.
Temp.
102-6 Pulse 82
a.m.
?
101-8 101-2
p.m.
?
99-8
a.m.
?
? ? ?
78 80 75
Respirations ? ?
? ?
22 20 20 18
He had profuse sweating an hour after the administration of the drug, and states he felt drowsy during the morning, but otherwise no bad effects were noticed. Next morning his fell to normal, and temp, was 99*4, at 8 a. m. it more fever, and was disfrom hospital. Case 5.?Pte Hurree Dhoree : cetat 27 yr. service 9 years : was originally admitted into
subsequently, he had charged the next day
no
hospital on May 1st last, suffering from acute' pneumonia, he had been a month in hoshad improved, but had a relapse comand pital, with fever from the 1st June, from plicated he was ordered Phenacetin, and his date which
temperature chart clearly shows the anti-thermic action of the drug. In this case also antipyrin, and antipyrin combined with quinine were also tried, but he complained of headache after their administration next morning, and no such illeffects were caused by Phenacetin. Sulphonal also was ordered with beneficial results as an hypnotic in this case.
DR. HEHIR ON SANITATION.
Aug., 1889.]
*
229
This patient was sent to his home on medical and sulphonyl as an hypnotic and antineuralgic agent?. Dr. Dujardin-Beaumetz in referring certificate on the 17th instant. to the therapeutic action of Phenacetin states Case 6.?Naik Mahabir Sing : cetat 25 years ; service 7 years: admitted on the 14 June last, "Like all analgesic antithermics the Phenacethey lower temperasuffering from ague with a slightly enlarged tins have a doable action,and these properties of and soothe ture his pain," spleen. On admission temperature was 101 *4, and he was at once ordered Phenacetin the drug were characteristically marked in my case No. 3, in which not only did the drug grs. viii, and this reduced his fever to 101? but at 11 o'clock the same night his tempera- reduce temperature, but the acutely painful joints Next morning when were also much benefited by its administration. ture again rose to 102'8. also states that " Phenacetin his I visited the patient, temp, was 101-8, and The same authority he was ordered Phenacetin grs. viii with the in febrile conditions shows itself superior to Antipyrin in producing marked anti-thermic effects following satisfactory result?viz. At 8 a m. Temperature 101-6 Pulse 95 Respirations 24 without Toxic phenomena," and in none of my 100 6 ? 80 20 cases have I observed any ill-effects attributable ? ? ? 10 a.m. 98-8 ? 78 20 4 p.m. ? The perspirato the administration of this drug. He did not perspire much till 4 p.'m., when tion caused in most of my cases after its adminismost profuse perspiration supervened. He subse- tration is a point I consider favourable to the quently had no further fever, and was discharged drug in the treatment of these cases. Unfortuto duty well on the 16th instant. nately Phenacetiu is but slightly soluble in cokl water, causing a difficulty on its administration, Notes on Sulphonal as an Hypnotic. In some of the above cases and in others I and also owing to its insolubility, it cannot be have lately prescribed Sulphonal to counteract subcutaneously injected ; to obviate these diffiS* insomnia, headache, pain, &c., with beneficial culties, I believe,Messrs. Burroughs, Welcome & this and have Co. Tabloids, short from compressed I and prepared believe results, my experience that this drug is also very useful in those cases would be a convenient form to prescribe it. In Sulphonal there is no doubt we possess a of a purely surgical nature complicated with insomnia and pain. In one case, a fracture of safe, sound narcotic and hypnotic, it produces the left arm with scalp wound and general contu- sleep in about an hour's time, not a sound sleep sions about the head and face, in a man who had apparently, but dreamless and succeeded by a fallen accidentally down a well. Sulphonal in condition of comfort on waking if the dose administered has not been excessive. It is further grs. xv doses was regularly administered for to occasion no disturbance of the heart's some time at bed time?and always caused the stated in action hypertrophy and in those cases of inpatient to sleep with comfort, but when this drug In an- somnia, neuralgia, inertia, &c., which are so comwas omitted, he passed restless nights. other case of insomnia in an officer Sulphonal monly met with in the tropics, I feel certain and comproved beneficial in causing a good night's rest that Sulphonal will prove of great use with no ill-effects next morning, although the fort. August 2nd, 1889. dose in this instance was a large one. in a of case I also tried Sulphonal gonorrhoea with chordee with the following result. On June 13th last the patient had a dose of grs. xx at bedtime, and next morning he stated that he had slept well, but got up twice during the night to micturate and had no erection during the night, but complained of feeling drowsy on awakening. The next night he again had another dose with a like result,?that he slept well and had no chordee, and subsequently no further treatment was necessary so far as this painful ?
?
symptom was concerned. Remarks.?From my clinical observations on the use of these two drugs, viz., Phenacetin and
I am of opinion we have in them two useful medicines in the treatment of those cases so commonly met with in India and other tropical countries, viz., those cases of fever, either intermittent or continuous, the result of malaria or climate, and in that numerous class of cases of a neuralgic or nervous nature which no doubt in these countries are also traceable to a
Sulphonal,
most
malarious origiu.
Phenacetin
as an
antithermic
,v
general. Physical Properties?Are as follows : a white crystalline powder, free from odour and taste,
it melts at a temperature of 135?c, is not soluble in cold water but is dissolved to a certain extent in hot water, but most readily in alcohol. Discovery.?Tt was originally prepared in 1886 by Dr. O. Hinsberg, and in the subsequent year satisfactory results were obtained by Professor Bemberger, whose experiments were published by Dr. Kobler?* In France, M. Lepine made public his experiments about the same time as Dr. Dujardin-Beaumetz, whose paper " On the Phenacetins," was read at the Meeting of the British Medical Association held at Glasgow in August, 1888. In the same year Drs. Misrachi and Refat published an important paper on the subjectf which was read before the Society of Medicine of Salonica. Therapeutic Properties.?It is in a marked degree an antipyretic and its anti-thermic action on the system is of longer duration than is the case after the administration of other antipyretics. In most cases under my observation, it had a diaphoretic action aud caused copious sweating, but in 110 case have I noticed any toxic phenomena attributable to the drug itself. It also has a sedative effect when given in cases of neuralgia, either cranial or facial, sciatica, &c., uncomplicated with a high temperature, and it is stated to have a beneficial effect iu the cases when given in doses commencing with 8 grains, but in prescribing this drug for such cases, it is necessary to bear in mind the results of the researches of Drs. Misrachi and Refat who found that Phenacetin was soluble in Lactic Acid at a temperature of 33*c and this fact, apparently would account for its rapid absorption when administered, since Lactic Acid is usually present in the stomach, so possibly in those cases in which Phenacetin fails to give relief, the failure may be due to the absence of that acid in the stomach, and the indication then naturally would be the addition of a little Lactic Acul. The French observer, M. Lepine, states that Phenacetin affects the blood less than antipyrin or antifebrin, and that doses of even 60 Wiener Med. Wochenschr. 1887?26 and 27. a, l'efcude de la Phenacetine?Bull Gen de Therap, tome LXIV, p. 481?1S88. *
f Coutrib
228
THE INDIAN MEDICAL GAZETTE.
do not effect the heart or cause cyanosis. In the few cases quoted below which I have taken at random, it will be seen that Phenacetin was given in continuous and intermittent fevers of malarial or climatic origin, in pneumonia, rheumatism, neuralgia, &c. Referring to the temperature charts of the fever and acute cases, the anti-thermic actiou of the drug will be seen to be very marked, but of its anti-neuralgic action I cannot, so far, speak definitely. From my observations on this drug, I must assign another important therapeutic quality to Phenacetin, which, apparently, has not previously been observed, and that is, its decided diaphoretic action when given in cases with a high temperature. In comparing Phenacetin with other antipyretics iu the treatment of malarious or continuous fevers, it has a decided advantage, for in all these cases it was administered whilst the fever was actually at its highest., and its effects were to cause diaphoresis and a lowering of the temperature, whereas in the cases treated by antipyrin, quinine, &c., these drugs are given only in the intermissions of fever, and usually simple diaphoretics are administered whilst the fever exists?hence I consider Phenacetin is indicated in preference in the treatment of these cases.
grains
Epitome of
cases.
[Aug.,
1889.
of this
ing
drug, aucl its permanent effects in reductemperature?copious perspiration was
caused in this
case after its administration. Case 3.?Drummer Buston : cetat 30 : service 12 years: was admitted on June 9tli last, suffering from rheumatism and painful joints ; both knees being swollen, hot and acutely painful. At 4 p.m. on the 3rd day after admission his temperature was 100-8, when he Imd a dose of Phenacetin with the following result:?
At '4 p.m. ? 6 p.m. 8 p.m. ?
This
100-8 Pulse 106 Respirations 26 98 100-2 26 ? ? 84 98-6 22 ? ?
Temperature ? ?
to perspire copiously about 6 p.m., and stated his joints were less painful, and no ill-effects of the drug were noticed, and he had no vomiting, headache, &c. At bed-time he had a dose of Sulphonal grs. xx, and slept well till the morning. Next morning his tem? perature was 100 6, when he again had another dose of Phenacetin which reduced the temperaHe slept well after a dose of Sulture to 99'2. phonal that night, and subsequently he did not have any fever, and was ordered Mistura Potassii Iodidi ter in die, and locally iodine application to his joints which were bandaged by flannel bandages over cotton wool. On the 16th instant he was well enough to leave hospital, and
patient began
o
proceeded
on
furlough.
Case 1.?Private Saleek, age 19 years : service 2 years: was admitted into hospital on the He had a 31st of May last suffering from ague. of 103? and was on admission, temperature ordered diaphoretics with cinchona alkaloid in His temperathe intermissions of the fever. ture, however, never fell below 100?. On the 5th of June his temperature rose to 104?, and he was ordered Phenacetin grains viii and another like dose an hour subsequently ; his temperature having fallen in this hour to 103*6. Next morning his temperature was normal, but it again rose to 102*6 in the evening, when he again had another dose of this drug, and his temperature again fell. Subsequently he had little or no fever to speak of, but being debilitated tonics were ordered, and he was discharged well from the hospital on the 16th instant. In this case sulphonal was also administered in xv a grain dose as a hypnotic with good
Case 4.?Lance Naik Ramchunder Ranav : cetat 26 years : service 8 years : stated on admission that he had been suffering from fever for the past two days. On admission (June 14th last) his temperature was 102*6, and he was at once ordered Phenacetin grs. viii with the following result, viz:?
Case 2.?Private Beni Aheer : cetat 19 years : service 1 year: came to hospital on June 1st last suffering from fever. This patient had more or less continuous fever for the first four days in hospital, his temperature ranging from 99? to 103?. This maximum of temperature was reached about midday on the 5th instant, when he was ordered Phenacetin grs. viii. In an hour the temperature was reduced to 101?, and gradually fell to normal, and since that date the patient had no recurrence of fever at all. This case markedly proves the antipyretic action
double
results.
8 9 11 4
A.M.
Temp.
102-6 Pulse 82
a.m.
?
101-8 101-2
p.m.
?
99-8
a.m.
?
? ? ?
78 80 75
Respirations ? ?
? ?
22 20 20 18
He had profuse sweating an hour after the administration of the drug, and states he felt drowsy during the morning, but otherwise no bad effects were noticed. Next morning his fell to normal, and temp, was 99*4, at 8 a. m. it more fever, and was disfrom hospital. Case 5.?Pte Hurree Dhoree : cetat 27 yr. service 9 years : was originally admitted into
subsequently, he had charged the next day
no
hospital on May 1st last, suffering from acute' pneumonia, he had been a month in hoshad improved, but had a relapse comand pital, with fever from the 1st June, from plicated he was ordered Phenacetin, and his date which
temperature chart clearly shows the anti-thermic action of the drug. In this case also antipyrin, and antipyrin combined with quinine were also tried, but he complained of headache after their administration next morning, and no such illeffects were caused by Phenacetin. Sulphonal also was ordered with beneficial results as an hypnotic in this case.
DR. HEHIR ON SANITATION.
Aug., 1889.]
*
229
This patient was sent to his home on medical and sulphonyl as an hypnotic and antineuralgic agent?. Dr. Dujardin-Beaumetz in referring certificate on the 17th instant. to the therapeutic action of Phenacetin states Case 6.?Naik Mahabir Sing : cetat 25 years ; service 7 years: admitted on the 14 June last, "Like all analgesic antithermics the Phenacethey lower temperasuffering from ague with a slightly enlarged tins have a doable action,and these properties of and soothe ture his pain," spleen. On admission temperature was 101 *4, and he was at once ordered Phenacetin the drug were characteristically marked in my case No. 3, in which not only did the drug grs. viii, and this reduced his fever to 101? but at 11 o'clock the same night his tempera- reduce temperature, but the acutely painful joints Next morning when were also much benefited by its administration. ture again rose to 102'8. also states that " Phenacetin his I visited the patient, temp, was 101-8, and The same authority he was ordered Phenacetin grs. viii with the in febrile conditions shows itself superior to Antipyrin in producing marked anti-thermic effects following satisfactory result?viz. At 8 a m. Temperature 101-6 Pulse 95 Respirations 24 without Toxic phenomena," and in none of my 100 6 ? 80 20 cases have I observed any ill-effects attributable ? ? ? 10 a.m. 98-8 ? 78 20 4 p.m. ? The perspirato the administration of this drug. He did not perspire much till 4 p.'m., when tion caused in most of my cases after its adminismost profuse perspiration supervened. He subse- tration is a point I consider favourable to the quently had no further fever, and was discharged drug in the treatment of these cases. Unfortuto duty well on the 16th instant. nately Phenacetiu is but slightly soluble in cokl water, causing a difficulty on its administration, Notes on Sulphonal as an Hypnotic. In some of the above cases and in others I and also owing to its insolubility, it cannot be have lately prescribed Sulphonal to counteract subcutaneously injected ; to obviate these diffiS* insomnia, headache, pain, &c., with beneficial culties, I believe,Messrs. Burroughs, Welcome & this and have Co. Tabloids, short from compressed I and prepared believe results, my experience that this drug is also very useful in those cases would be a convenient form to prescribe it. In Sulphonal there is no doubt we possess a of a purely surgical nature complicated with insomnia and pain. In one case, a fracture of safe, sound narcotic and hypnotic, it produces the left arm with scalp wound and general contu- sleep in about an hour's time, not a sound sleep sions about the head and face, in a man who had apparently, but dreamless and succeeded by a fallen accidentally down a well. Sulphonal in condition of comfort on waking if the dose administered has not been excessive. It is further grs. xv doses was regularly administered for to occasion no disturbance of the heart's some time at bed time?and always caused the stated in action hypertrophy and in those cases of inpatient to sleep with comfort, but when this drug In an- somnia, neuralgia, inertia, &c., which are so comwas omitted, he passed restless nights. other case of insomnia in an officer Sulphonal monly met with in the tropics, I feel certain and comproved beneficial in causing a good night's rest that Sulphonal will prove of great use with no ill-effects next morning, although the fort. August 2nd, 1889. dose in this instance was a large one. in a of case I also tried Sulphonal gonorrhoea with chordee with the following result. On June 13th last the patient had a dose of grs. xx at bedtime, and next morning he stated that he had slept well, but got up twice during the night to micturate and had no erection during the night, but complained of feeling drowsy on awakening. The next night he again had another dose with a like result,?that he slept well and had no chordee, and subsequently no further treatment was necessary so far as this painful ?
?
symptom was concerned. Remarks.?From my clinical observations on the use of these two drugs, viz., Phenacetin and
I am of opinion we have in them two useful medicines in the treatment of those cases so commonly met with in India and other tropical countries, viz., those cases of fever, either intermittent or continuous, the result of malaria or climate, and in that numerous class of cases of a neuralgic or nervous nature which no doubt in these countries are also traceable to a
Sulphonal,
most
malarious origiu.
Phenacetin
as an
antithermic
,v
