In my first editions I gave a conspicuous place to the use of coal tar derivatives as remedies that control fevers. During, the fifteen years that followed, these remedies did not gain ground in the opinion of the profession. Acetanilide and phenacetin perhaps held their own. Antipyrine was largely dropped except for pain. Exalgin is used in but very few conditions. I therefore have not in this rewriting given them separate space.
Amtipyrine in its physiological action is similar to that of phenacetin, but more pronounced. All the four remedies herein included, produce pallor: first by impeding the circulation through depression, and secondly after protracted use, by destroying the red corpuscles and introducing a new toxin—methemoglobin. Cyanosis will follow large doses with all. There is languor, trembling, and with antipyrine especially, profuse sweating, fall of temperature, impeded respiration, increased feebleness, and rapidity of the pulse, coma, and difficult breathing with full extreme doses with profound collapse.
Antipyrine relieves pain to a larger extent than the others, but the almost invariable depression caused, prevents its general use. If it were not for this it would be a valuable therapeutic remedy. It reduces temperature, and controls nervous excitability.
Acetanilide is a safer remedy especially when combined with a sodium salt and caffeine. Its use is reduced to its control of headaches, but so many unpleasant results have occurred that it is under the ban. Its continued use is not advised because of its action named above on the red corpuscles. Fewer accidents occur with this remedy than with antipyrine. Five grain doses are within safe bounds, though this dose has produced alarming symptoms. None of these remedies should be used except in sthenic cases, and then repeated but few times.
Of all four, probably Phenacetin is the safest. It regulates sthenic fevers to a certain extent, relieves pain, and distress, unlocks secretions, produces a moist tongue, soft skin and full pulse. Cyanosis does not as readily follow it, as the others. These remedies are all erratic in their action. They are not like the organic agents; these exercise a steady, uniform, smooth, regular, permanent influence acting in perfect. harmony with the natural forces in whatever they do, especially in overcoming fevers. There is no perceptible reaction after their action, while after these synthetic remedies the temperature recurs in many cases higher than before.
Exalgin never has held a high place except for some form of pain. For some special purposes it is relied upon. It is now no longer used as an antipyretic. I at one time cured a number of cases of chorea with this remedy, that would not readily respond to our other methods. At first I thought it would be an addition to our list, but later when I came to treat the feebleness, anemia and irregularity of the heart, I found in many cases, when only two grains, three times a day, was given, I discontinued it entirely. I am confident that a thorough knowledge of the organic remedies will produce in every way a more satisfactory class of remedies than can be secured from the use of these erratic chemical products.
The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.