Medical Jurisprudence And Toxicology

656 MEDICAL JTDRISPRtTDENCE

A dose of 28 grains of dial has caused death, but recovery has followed a dose of
about 40i grains (2.7 grammes).82

Allonal, Amytal, Bromural, Nembutal, Neonal, Evipan, Proponal, Pernocton, Phano-
dorm, Sodium amytal, Soneryl, etc. are proprietary drugs containing derivatives of
barbituric acid and possessing hypnotic properties. Many of these have produced
poisonous symptoms when taken in large doses and some have caused death. Six grains
of nembutal caused the death of a person suffering from Graves' disease, A young man
died after taking 20 " Nembutal " tablets and about 9 " Oblivon ' capsules. L, C.
Nickolls identified the presence of methylpentynol in quantity equivalent to about 9
oblivon capsules and about 7J gr. of a barbiturate the two acting synergically had proved
fatal. Oblivon is an acetylene alcohol and should not be taken together with barbitu-
rate. The result is similar to that of alcohol and barbiturate taken together. s:{ A young
nurse died after taking 75 grains of sodium amytal and 18 grains of nembutal. On the
other hand, recoveries have followed the doses of 120 and 156 grains of sodium amytal.8*

ANTIFEBBIN, ANTIPYRIN AND PHENACETIN

Antifebrin (Acetanilide, Phenyl-acetamide), CoHsNH.CO.CH,.— This is a colourless
odourless, crystalline substance, having a slightly pungent taste. It is soluble with
difficulty in cold water but freely in hot water, alcohol, wine, solvent ether and chloro-
form. It is a non-official preparation, the dose being 2 to 5 grains.

" Daisy " or " headache J> powders sold in the chemist's shop contain from 4 to 10
grains of antifebrin. Exalgin (methylacetanilide) occurs in colourless crystals, and has
a slight saline taste. Dose, J- to 2 grains.

Antipyrin (Phenazone, Phenyl-dimethyl-isopyrazolone), CnHtaONa. — This occurs
in small, colourless crystals, possessing no odour but a slightly bitter taste. It is freely
soluble in water, alcohol, solvent ether or chloroform. Dose, 5 to 10 grains.

Phenacetin (Acetphenetidin, Acetophenetidin), CoH* (O.C:-Hn).NH,CO.CH!1.— This is

an odourless and slightly bitter substance, having white, glistening, scaly crystals. It is
very slightly soluble in water,, insoluble in glycerin but soluble in 20 parts of alcohol.
Dose, 5 to 10 grains.

These drugs are used as antipyretics, analgesics and sedatives, Poisonous symptoms
have occurred from the administration of doses larger than the medicinal ones. In large
doses they destroy the red blood corpuscles, and induce the formation of methaemoglobin,
setting it free in the blood plasma. Antifebrin and phenacetin are oxidized in the body
to para-aminophenol which, in combination with sulphuric acid or glycuronic acid, is
eliminated by the kidneys. Antipyrin is not oxidized in the body, but is excreted in
the urine combined with sulphuric acid.

Symptoms.— Nausea, vomiting, vertigo, cyanosis, great prostration, slow breathing,
quick, irregular and imperceptible pulse, cold, clammy skin, subnormal temperature,
collapse and death. Urticaria! rashes may appear on the skin, especially in cases of
poisoning by antipyrin.

Many persons become addicts through the long-continued use of these drugs, and
may suffer from a form of chronic poisoning which is characterized by cyanosis, dyspnoea,
weakness, anaemia, wasting, and dark- coloured urine. When these drugs are withdrawn
suddenly, they may cause symptoms of acute mania.

Fisher85 reports the case of a man, aged 47, who took as much as 8 grammes of
antifebrin and 3 grammes of phenacetin daily over a long period. The first symptoms
complained of were marked cyanosis of a peculiar lavender hue of the face, weakness
of the muscles, coarse tremors of the tongue and hands and some inco-ordination. The
temperature in the mouth varied from 96°F. to 98°F. The pulse rate ranged from 60
to 100 per minute and respirations from 14 to 20. The blood was of a peculiar dark-
brownish colour due to the presence of methaemoglobin. Marked mental symptoms
developed after the withdrawal of the drugs. The patient became confused, disturbed
and irrational and soiled his clothing with urine and fasces. He developed ideas of
reference and persecution, but no restraint was necessary. In the course of a week or
two the mental symptoms gradually disappeared. Two months after the withdrawal he
felt much better, gained 15 pounds in weight and was stronger. The tremors had
disappeared.

Fatal D^e.— Uncertain. Five to fifteen grains of antifebrin have proved fatal to
children, adults with weak hearts and old people, while above 30 grains would probably

•r Jr S^^^r Dot^ ?ul1 et Mem' Soc' Med- des- H<>p. de Paris, Oct. 27, 1927, p,
1392 ; Bnt Med. Jour., Epitome, Dec. 31, 1927, D. 103
, 83. Brit Med. Jour., Jan. 29, 1955, p. 296.

84. W. J. Bleckwenn and M. G. Hasten, Jour. Amer. Med. Assoc,, Aug. 6, 1938, p. 504.

85. Jour. Amer. Med. Assoc., March 11, 1933, p. 736.