486 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1940 



ridden patients may become so disoriented and maniacal, that cessa- 

 tion of drug therapy may be necessary. Nausea and vomiting are 

 usually not severe enough to necessitate suspension of sulfanilamide 

 treatment. 



A majority of the patients taking sulfanilamide develop varying 

 degrees of cyanosis of the skin and mucous membranes. This bluish 

 discoloration is due to the conversion of a part of the hemoglobin into 

 methemoglobin, and rarely sulfhemoglobin. Although the morbid 

 appearance of the patient may startle the uninitiated, we do not con- 

 sider methemoglobinemia a contraindication for further administra- 

 tion of the drug. 



A more serious toxic reaction is so-called drug fever. It usually 

 occurs after an individual has taken sulfanilamide for several days. 

 While the patient is receiving sulfanilamide, the temperature may 

 approach normal, and then begin to rise again, sometimes quite high. 

 The problem then confronting the physician is whether this secondary 

 rise in temperature is due to a spread of the infection or due to drug 

 sensitivity. Obviously, the treatment is quite different for each condi- 

 tion. When the fever is due to sulfanilamide, its administration 

 should be discontinued at once. The appearance of drug fever may 

 herald the onset of more serious toxic reactions if therapy is continued. 

 "Wlien the drug is omitted, the temperature again approaches normal. 

 We have been impressed by the clinical observation that once a patient 

 has had drug fever, it is likely to occur again when only a single dose 

 of sulfanilamide is given at a future time. This toxic reaction em- 

 phasizes again the inherent danger of self-medication without the 

 attendance of a physician. It also serves to express an opinion shared 

 by physicians in general that sulfanilamide should only be given to 

 those patients having an infection that threatens their lives, or is 

 likely to produce serious complications. If the drug is taken indis- 

 criminately by individuals, and drug sensitivity results, it may be 

 impossible to give sulfanilamide in the future when it is definitely 

 indicated as a life-saving measure. 



Various types of skin eruptions occur as a result of sulfanilamide. 

 These eruptions often appear along with drug fever. The skin lesions 

 may simulate those occurring in measles and scarlet fever. Intense 

 itching of the skin may be present. There may be hemorrhages into 

 the skin. Angioneurotic edema has been described. With the first 

 appearance of the eruption, no further sulfanilamide should be given. 

 Skin lesions may present themselves at a subsequent time when only 

 one dose of the drug is given. 



A more subtle toxic manifestation of sulfanilamide is liver dysfunc- 

 tion. This may or may not be accompanied by jaundice. In a few 

 reported instances, the damage to this vital organ has been so severe 



