6 ACETANILID, ANTIPYRIN, AND PHENACETIN. 



not use it now, because in his experience it had proven uncertain in 

 effect and untrustworthy. Still another said he did not use it at all, 

 and when asked why, said, "I am afraid of it." But a fourth 

 physician stated that he employed it to good advantage, and that 

 though he often noted " bluing of the skin," or cyanosis, he regarded 

 this symptom merely as a " signal " or warning as to the further 

 administration of the drug. 



Recent investigation indicates that all^ three of these drugs are 

 now used less than formerly by medical practitioners. Of the phy- 

 sicians who gave information on this subject in reply to an inquiry by 

 the Department of Agriculture, 66 per cent state that they use 

 acetanilid less frequently than formerly, nearly 66 per cent made the 

 same statement with regard to antipyrin, and 51.2 per cent with re- 

 gard to phenacetin. The reason given referred in almost every in- 

 stance to the toxic properties of these agents, particularly their de- 

 pressing effect upon the heart. The fact that they are poisons in the 

 true sense of the word is recognized by members of the medical pro- 

 fession, but it is doubtful whether the general public is aware either 

 of this fact or that they possess any possibilities for harm whatever. 

 Certainly there is nothing to indicate an appreciation of these qual- 

 ities on the part of the laity if one can judge from the ever-increasing 

 sale to the public of these drugs and preparations containing them. 

 It therefore appears that the people in general should be informed of 

 their poisonous properties and of the injurious effects which may 

 follow their ill-advised, prolonged, or habitual use. To this end, 

 the Department has recently instituted an investigation to determine 

 as far as possible the status of acetanilid, antipyrin, and phenacetin 

 as toxic agents. The investigation was conducted along two lines: 

 First, an inquiry addressed to medical practitioners in the United 

 States with regard to their personal experience with these drugs ; and 

 second, a study of the cases of poisoning recorded in medical litera- 

 ture. The results of this investigation are set forth in the following 

 pages. 



The purpose of the inquiry was not to depreciate in any way the 

 value of these substances as medicinal agents, but rather to furnish 

 information to the public which w r ould enable them to understand 

 that these remedies should be employed with caution in the absence of 

 reliable medical advice, as can readily be seen from the following 

 correspondence which passed between the Department and one of the 

 physicians who furnished information in reply to inquiries with 

 regard to his personal experience with these drugs : 



I have been using acetanilid now nearly eleven years, observing the following 

 rules without any but the desired results, either immediate or remote, as far 

 as niy observation goes. 



Never give more than 2.50 grains at a dose. 



