24 



ACETANILID, ANTIPYRIN, AND PHENACETIN. 



of collapse appeared. The ointment was discontinued and the symptoms gradu- 

 ally disappeared. 



The symptom which appears most frequently in the recorded cases 

 of poisoning by acetanilid is cyanosis. With but very few exceptions 

 it is a constant symptom, the depth of the discoloration ranging from 

 a mere dusky hue of the skin or mucous membrane to a color which 

 is described as " blackish-blue " or even " black." This symptom was 

 observed from the first and even in Cahn and Hepp's original article, 

 which marked the advent of acetanilid in the world of medicine, 

 cyanosis is casually mentioned 'as a side effect of the administration 

 of the drug. At that time but little significance was attached to its 

 occurrence. We now know, however, that it is an exceedingly un- 

 desirable symptom, inasmuch as it is due to a deterioration in the 

 quality of the blood caused directly by the presence of decomposition 

 products of acetanilid. Accompanying the cyanosis there was ob- 

 served in most of the cases prostration, which varied in degree from 

 mere depression of the bodily functions to actual collapse. 



In addition to these symptoms there were observed in many 

 instances vertigo, faintness, lividity of the face, a pinched and 

 anxious expression, dyspnea, excessive restlessness, increased perspi- 

 ration, coldness of the extremities, rapid and feeble heart action, and 

 in severe cases, stupor or coma. The occurrence of an eruption on 

 the skin is mentioned in only a very few of the recorded cases. This 

 is also true of disturbances of vision and of the functions of the 

 kidneys. 



The habitual use of acetanilid is specifically mentioned in 32, or 10.7 

 per cent, of the recorded cases of poisoning. This gives no conclu- 

 sive information, however, as to the actual extent of the acetanilid 

 habit, inasmuch as only those instances of habitual use are recorded 

 in which the ill effects were probably so severe as to cause the patient 

 to seek the advice of a physician. A consideration of the relative 

 number of cases occurring in different years is of value, however, 

 and shows a marked increase in the number of cases of habitual use 

 during recent years, as indicated in the following table : 



Case* of habitual use of acetanilid reported, 18901901'. 

 [No cases reported for the years omitted.] 



