g58 MEDICAL JURISPRUDENCE
being 5 to 10 grains. Certain proprietary drugs contain wnidopyrino as the chief ingre-
dient For instance, amidophen contains nmidopyrme, phonacotin, caHoino and dry
hyoscyamus extract. Compral consists ot amldopyrlno nnd trichloivthyl-uixithanp. Gardan
is composed of amidopyrme and novalgin. Allonal, cibalgin and vorumon, contain amido-
pyrine in combination with a barbiturate.
Long continued use of amidopyrino or its use in susceptible individuals may cause
aggranulocytic angina which is characterized by marked loucopetria, almost complete
absence of polymorphonuclear cells, fever, malaise, uucoration and oven sioughing of
the mouth and throat, prostration and death. The minimum fatal dose is considered
to be about 120 to 150 grains.
The treatment is the same as in poisoning by antifcbrin. Pentnucleotide intra-
venously is recommended as a treatment for ogranulocytosis.
Chemical Tests.—Ferric chloride solution gives a bluish-violet colour with amido-
pyrine solution. If a few drops of potassium nitric solution are added to an aqueous
solution of amidopyrine acidified with dilute hydrochloric acid, a violet-blue colour is
produced, which gradually fades and changes to a green colour,
CINCHOPHEN (PHENYLQUINOLINE^CAEBOXYLIC ACID)
This occurs as a white or yellowish powder or in crystals, bmng insoluble in water
and slightly bitter in taste. It is a pharmacopceial preparation and ia known as atophan,
phenoquin, agotan, atocin, nylofanol, quinophan, etc. and is given in 5 to 10-grain doses
as an analgesic in lumbago and sciatica, It is also said to increase the elimination of
uric acid from the blood in gout and rheumatic affections,
The drug is a dangerous poison and should be used with great care. Small doses
administered for a prolonged period may produce chronic dogon^rative changes in the
liver, while large doses may cause acute fatty degeneration, or even acute yellow atrophy,
of the liver.
The symptoms of poisoning are malaise, headache, gastro-intestinal disturbance,
jaundice, skin eruptions, palpitation, tachycardia and cyanosis. The urine is coloured
dark and contains albumin. Death has occurred in some cases from necrosis of the liver.
In a case 86 where a woman, 65 years old, died from cinchophcn poisoning, post-mortem
examination showed almost complete destruction of the liver, which was reduced to
less than half its normal size.
Thirty-seven and a half grains of cinchophen taken in ftve days caused death from
subacute yellow atrophy of the liver.87
The treatment consists of the withdrawal of the drug and administration of dextrose
and insulin. The drug has a cumulative effect, hence there should be frequent rest
periods during its administration.
SULPHANILAMIDE (SULPHONAMIDE OR PRONTOSIL ALBUM)
This is a term adopted by the American Council of Pharmacy and Chemistry as a
non-proprietary name for para-aminobenzenesulphonamide. It occurs in colourless
crystals or as a white, crystalline substance, is odourless and slightly bitter with a
sweetish after-taste and is but slightly soluble in water and alcohol It is a chemo-
therapeutic agent and was originally intended for use in hsemolytic streptococcal infec-
tions, but is now largely used in the treatment of erysipelas, peurperal sepsis, tonsillitis,
peritonitis, meningitis, gonorrhoea, pneumonia, otitis media and osteomyelitis.
The derivatives of sulphanilamide are sold under different proprietary names, such
as Prpntosil Soluble, Prontosil Album, Proseptasine, Soluseptasme; M and B 693 (Sulpha-
pyridine), Sulphathaazole, Sulphamethylthiazole, Bacteramide, Streptodde, Sulphona-
mide-P, Consulanyde etc. Sulphadianne, sulphamerazine, sulphamethazine, sulpha-
guanidme, succmylsulphathiazole and phthalylsulphathiazole have recently been added
to this group of drugs. rf
Sulphanilamide is a pharrnacopceial^ preparation, and is generally administered by
the mouth, the initial dose being 30 grains and subsequent doses being 15 grains every
four hours. The drug may be administered hypodermically or intramuscularly. It may
^° Łe STei\pr ^ctT "fra^ecaJly in a 0.8 per cent solution in normal saline
The treatment should be continued only for two to three weeks and the dose should be
reduced as the condition improves. *- *uwm
The administration of the drug for a prolonged period or in fevers of uncertain
nature usually gives rise to toxic effects and may cause death. Owing to idioWrasy
poisonous symptoms may appear in some cases after the administration of an ordinary
therapeutic dose. It should be remembered that children bear it -well.
86. Pharm. Jour., Jan. 2, 1943, Vol. 150, p. 6. " ' ' . .
87. Fraser, Brit. Med. Jour., Vol. IE, 1934, p. 1195.