Case of acetanilid poisoning in a woman, aged 26 years, who had taken S grains. Collapse with strong convul sive movements, partial loss of con sciousness, and great retching. Whisky, nitrate of strychnine, and—for two hours—artificial respiration induced re covery. 0. R. Siuniners (N. Y. Med. Jour., Mar. 24, 1000).
Case of fatal acetanilid poisoning. The patient, a man of 37, had taken six "headache powders" each contain ing 10 grains. He became delirious, complained of abdominal pain, vomited, and was slightly jaundiced. His tem perature rose to 100.2° P., the lips and nails became intensely cyanotic, respira tions shallow and frequent. The urine. of which 10 ounces were passed on ad mission. was nearly black and strongly alkaline. Auuria occurred, and six days later the man died. There was alter nate constipation and diarrhrea. and forty-eight hours before death the faces constantly showed blood-pigment, blood-clots, and corpuscles. Philip Brown (Amer. Jour. Med. Sciences, Dec., 1901).
While subnormal temperature may result from the administration of even small doses, it is not always present in cases of poisoning.
Subnormal temperature. in a man aged 40 years, produced by a second dose of 7 grains two hours after the first. T. M. Dunagan (Memphis Med. Monthly, Mar., '91).
The toxic properties of acetanilid too often appear when the drug is given in small doses. In some cases symptoms become so severe that a fatal result may be imminent, unless prompt treatment is employed. Having been widely adver tised as a universal analgesic, a large number of remedies for the relief of pain, under catchy titles, contain this drug as an essential ingredient. Fifteen grains is commonly considered the maximum dose, yet one-third of this quantity has been personally seen to produce alarm ing symptoms. Authors have occasion ally advised that 3 grains be given each hour, but patients reach the danger-line long before the maximum quantity was given in this way. Two 4-grain doses caused nearly fatal issue in a ease in an adult described by O. R. Summers.
Personal case in which the patient had taken four headache powders. The head ache powder had been taken each hour, beginning at nine o'clock and ending at noon. The surface of the body presented an ashen-gray appearance, the mucous membranes having a much darker hue.
The temperature was 90 degrees; pulse. 00; and respiration, 10. Digitalis, strychnine, and alcohol-baths with fric tion were employed, with dry heat to the surface. When the patient was able to swallow, a combination of aromatic spirit of ammonia, brandy, and capsicum was given. Twenty-four hours later the temperature was slightly subnormal, the dusky appearance of the face disap peared to a large extent, but the symp toms of cyanosis did not wholly vanish until the second day. The powders con tained 3 grains of acetanilid. 2 grains of bicarbonate of sodium, and 1 grain of caffeine; hence the total dose was 12 grains of acetanilid. Conclusion that under no circumstances should acetanilid be administered alone, but always guarded by a cardiac stimulant, while the intervals between doses should be sufficiently prolonged. Earps (Merck's Archives, June. 1901).
The cyanosis is probably due to the liberation of free aniline in the blood, and is more likely to occur when the acetanilid is imperfectly manufactured. An excess of aniline is present when the acetanilid employed gives a reddish orange precipitate with sodium hydro bromite.
Many of the toxic symptoms of ace tanilid so closely resemble those of aniline poisoning as to suggest the pro duction of that substance in the blood. There is a close relationship between the two bodies, and there is therefore some ground to suspect the occasional pres enee of aniline in samples. Editorial (Brit. Med. Jour., Dec. 22, '94).
Cyanosis is due to the liberation of free aniline in the blood, which disap pears soon afterward, as soon as it is eliminated by the kidneys and skin. A similar cyanosis, though more pro nounced, is found in the workmen of aniline-color works. C. F. Bachmann (N. Y. Med. Jour., May 22, '97).
Acetanilid is an effective agent for the treatment of wounds, causing rapid heal ing in subjects whose powers of resist ance to toxic effects are not greatly below par. In infants and aged people, for instance, the possibilities of untoward effects are greater than in youths or adult subjects. Idiosyncrasy may also enter for a share in the cases of poison ing reported. In the aged the resolutive process may be retarded by its use.