C . SUMNER WITHERSTINE, Philadelphia.
EXALGIN.—Exalgin (methyl-phenyl acet-amide or methyl-acetanilid) is pre pared by warming together menomethyl aniline and acetyl-chloride. It appears in beautiful acicular needles, which are with difficulty soluble in cold water, more readily in warm water, and more easily in dilute and concentrated alcohol. It is odorless and tasteless.
Doses and Physiological Action.—Ex algin may be given to adults in doses of 2 to 4 grains every two to four hours. A maximal daily dose of 15 grains should not be exceeded.
Doses of exalgin, as set forth in the various formularies, are too high. The maximum dose for twenty-four hours should be, for a man, 4 grains, and for a woman, 2V, grains. M. Bardet (Jour. de Pharm. et de Chilli., No. 8, p. 413, '9S).
Children from 1 to 12 years of age may be given to 1 grains three times daily. Owing to its pleasant taste, it may be given dry on the tongue, in wafers, and dissolved in wine or water, to which a little alcohol has been added (exalgin, 1 part; alcohol, 1 parts; sweetened water, 125 parts).
Sodium salicylate added to exalgin in creases its solubility for hypodermic use (exalgin, 10 parts; sodium salicylate, 11 parts; water, 100 parts). In short, the dose of exalgin is one-fifth that of anti pyrine.
The physiological action of exalgin is similar to that of acetanilid. It is capa ble of acting energetically upon sensibil ity and the motor nerve-system, and later upon the respiratory and circulatory sys tems. In tonic doses it acts upon the blood-corpuscles like all poisons of the same class and diminishes the energy of the gaseous changes therein. In animals, mortally tonic doses produce violent con vulsions and insensibility; death is from asphyxia. In tonic non-mortal doses convulsions are observed. In man the temperature is not reduced except when exalgin is administered in small, repeated doses during several hours. It acts first upon sensibility; its action upon thermo genesis conies later and is accessory.
With feverish patients untoward effects are accentuated; hence the presence of fever is a contra-indication to its use. While large doses in animals do not pro duce albuminuria or hoematuria (Brig onnet), in man the quantity of urine de creases, the color becomes darker, and urobilin and indican are present, if the dose is large. Arterial pressure occa sionally falls slightly, though usually there is a rise, with a decrease in pulse rate. Vasomotor disturbances are indi cated by free or profuse diaphoresis.
Exalgin Poisoning.—No fatal poison ing from exalgin has been reported, al though serious symptoms have followed so small a dose as 5 grains. In this case, an asthmatic, the effects of this small dose were noticed within five minutes. Unconsciousness was associated with shallow, infrequent, and failing respira tion. The lips and finger-tips became cyanosed and the extremities cold; the pupils were fixed and widely dilated; knee-jerks were absent. Later an evi dent tendency to heart-failure. The urine could be drawn with catheter (se cretion suppression). In other cases larger doses have produced numbness and tingling, vertigo, temporary blind ness, tinnitus aurium, headache, profuse sweating, cyanosis followed by pallor, formication, etc. The brain seems to be the first organ affected and the first to recover. General motor paralysis with dyspncea, pallor, palpitation, and phys ical prostration were the symptoms in another case. There is sometimes a feel ing of alternate expansion and contrac tion of the head.
Case of poisoning reported by two 3 grain doses of the drug in a boy 14 years of age. The symptoms came on about an hour after the administration of the second dose, and consisted of great dysp ncea, intermittent pulse, and dilatation of the pupils. Recovery took place under hypodermic injections of ether and alcoholic stimulation. The drug is dangerous in large doses, and of no use as an analgesic, in small quantities. E. T. Flynn (Brit. Med. Jour., Jan. 10, '91).