MODERN" ANTIPYRETICS IN REMITTENT FEVER. By Sueoeon P. 0. W.
HA.ILEY,
Indian Medical Service.
The 3ome
cases
interest,
narrated below may as
showing
possibly
the action of
be of of
some
MODERN ANTIPYRETICS IN REMITTENT FEVER.
June, 1888.]
169
"
" At 7-30 temperature Autifebrine gr. 10. introduced in remit8-30 100?. At 99?. Considerable temperature tent fever. I may say at once that these cases which were nearly all of the adynamic type, action of skin. No depression of the pulse, or other unpleasant symptom. were treated throughout with small doses of: February 6th.?Temperature 102*6? in the Tinct. digitalis continuously as a cardiac tonic, 10. Temperature fell and, of course, with quinine in the usual doses evening. Antifebrine gr. Profuse sweating. to 99? in two hours. Pulse during the remission, together with stimulants, weaker. only slightly very as I the shall not allude, to all &c., required. February 7tli.? At 2 P. M. a temperature of details of the treatment, but only to that of the 105 '4? was reached. Pul se 100. Respiration pyrexia, the object being to compare the different 40 Antifebrine gr. 7 was adminisminute. per drugs with one another. At 3 p.m. temperature 103-6?. At 4 p.m. Case I. Remittent fever treated by anti- tered. 102-4?. febrine throughout the disease. February 9th.?Temperature 104'6? in the S. Durson Singh, cet. 18, February 25th Antifebrine gr. 10 bringing temadmitted with frontal headache, congested con- morning. to 103'S?. Left lung almost entirely perature junctivas. Temperature 101-2?. Fine crepita- consolidated. tions of middle of left lung and tubular breathFebruary ll?/i.?Temperature in the morning. 105-4?. Is becoming rapidly weaker. Pulse ing 12 at February 27 th?Temperature 103'8?; Cannot swallow. Hypodermic injecrunning. P.M. Antifebrine gr. 10 in brandy ^ oz. ; at 2 tions of ether 3 and brandy alternately. gr. 98-6?. P.M. Profuse sweating. Temperature Enema quinine gr. 30 at midday. Death at Pulse somewhat weaker. First cardiac sound
the
autipyre tics recently
?
not
quite
so
3 p.m.
good.
JBebruary 2Sth.?Temperature
at
103-4? Fr. Antifebrine gr. 7. At 2 At 5 p.m. 99*? 100*8?. perature
February
12 p.m.
M.
P.
the antifebrine certainly caused less and lowered the tempereffectually. This was, however, a very severe The time case, complicated moreover with pneumonia. taken by the antifebrine to lower the temperature was ou The effect on the skin was, an average one to two hours. on the whole, greater than that of the antipyrin. The Note.?In this
Tem- depression ature as
29th.?Temperature kept slightly
case
than the
antipyrin,
above 103? all day. March 2nd.?Complete consolidation of left temperature kept down during a time varying from 5 or lung. At midday temperature 103-4?. Antifeb- 6 to 8 hours. The urine was slightly increased on one rine gr. 7. Temperature fell to 102?. or two occasions when it was measured, but not markedly March 3rd.?Evening temperature 100? only. so. I may add that neither antifebrine not antipyrin has ever caused vomitting or collapse, in these cases. Pulse 100. Respirations 40 per minute*. March 6th.?Temperature normal. Pulse 80. Case No. 3. Remittent fever treated by kairin. Respirations 30 per minute. From this time convalescence set in. S. Nabi Bux, cet. 23, admitted, March 3rd, for Note.?In ibis case antifebrine produced a very marked vomiting, diarrhoea, frontal headache, &c. diminution in temperature on two occasions, producing a Temperature 101-6?. Evening temperature reduction respectively of 5*2? and 4-4? without causing 104-0?. Kairin gr. 7 was given, which brought symptoms of depression otherwise than a slight slowing the to 102? in an hour. temperature in of of the pulse and reduction pulse tension. Given March a kth.?Eight liquid motions since last brandy, it produces very little depressing effect, and small dose of 7 grs. is usually effectual. night. Ordered gallic acid and pulv. doveri 5 of each every quarter hour. Severe remittent fever treat- gr. Case No. 2. consolidation of upper lobe of Well-marked ed first by autipyi'in, subsequently by antifebrio-ht typically pneumonic. Sputum lung. rine. At 3 p.m. temperature 104-8?. Kairin gr. 7 brought at. S. Bunsi Ram, 23, admitted, January it to 103? at 6 P.M. Profuse sweating. Pulse 26th, for headache (frontal,) vomiting, tongue altered. scarcely coated with creamy fur. Temperature on March 5th.?Temperature 104-?. At 1 p.m. admission 104?. Antipyrin in two doses resAt 3 p.m. 103*4 one liquid Kairin gr- 7. pectively of gr. 15 and gr. 10. Temperature stool. 103? after an hour: profuse sweating. March 7th.?At 3 p.m. temperature 103'4?. January 29th.?Temperature at noon At Kairin gr. 7. At 4 p.m. temperature 102-8?. Antipyrin gr. 10. Temperature fell to 101'4 , 10 p.m. 101?. to 99?. and late in the evening
104^.
January 30^.?'Temperature
at
9
10
r.M.
r. m.
rose
gr. 20 in two 100.?
Antipyrin
temperature
104? doses; at to
^
January 31s*.?Evening temperature
Antipyrin
gr. 15.
at
perature 100?. At 10
6
p.m.
P.M.
At 8
103?.
p.m. tem-
temperature 99?.
February 3rd.?Temperature
102? at 6-30 P.M.
March 8th.?Morning
temperature normal;
still very furred in centre, lip and edges clean. Lung clearing up. Convalescence from this date. Case No. 4. Remittent fever of the asthenic type treated by minute doses of Tinct, aconite. Recovery on the 5th day.
tongue
23
THE INDIAN MEDICAL GAZETTE.
170
February 19th.?R. Kandhai Singh, cet. 20, admitted with fluslied face, suffered conjunctiva. Ordered Pulse full and somewhat bounding. diaphoretics. Temperature rose to 105 m the evening. This case did not come under my observation until the morning of the third day. r\
?
?
(February 2). February 20th.?Evening temperature 104?. Diaphoretic mixture continued with quinine during remission. At 10 a.m. temperature 104?. Drop doses of Tinct. aconite ordered every 15 minutes.
11 a.m. at 3 p.m.
102,8? ; The 99*2?. minutes for three in the evening. but not excessive P.M.
temperature 103-8?; at 1 102*6"; at 4r. M. 102*2?;
r.M.
:it 6 aconite was given every 15 Pulse slightly weaker hours. No depression. Skin moist, action.
February 2'2ud.?Morning temperature 102?. Pulse 1'28. Respirations 32. At, 4 a.m. temperature 102?. Drop doses of Tinct. aconite At 1 p.m. temperature every 15 minutes.
103?';
at
2 p.m.
103?; at Aconite given
P.M. 102?. for three hours, beginning O
3 P.M.
102
8?;
at 6
every 15 minutes o'clock. 101 8?. temperature February 23rd.?Morning Tine, aconite in in. doses as before. Atmidda}* temperature 99?; at 6 p.m. 98*8?. J
February
respirations
O
at 4
24 th.?Temperature, normal ; good recovery.
Case No. 5. with antipyrin.
pulse
and
Severe remittent fever treated Death on 8th day.
January 16th.?Shaik Karim, cet. 22, admitted with headache, vomiting, &c. Temperature admission 104?Fr. on Diaphoretic mixture. In the evening the temperature rose to 106?; when antipyrin gr. 20 was given bringing the temperature down to 104?Fr. Pulse 100. Respirations 46 per minute.
Evening temperature at 6-30 106*0?. Antipyrin gr. 10; at 8 P.M. temperature 104?. Tongue dry and cracked. Sordes on teeth. Signs of pneumonia in right lung. 19th.?Evening temperature 105?. Respirations 30. Pulse 110. Antipyrin gr. 10, bringing temperature to 102?. 20th.?Low muttering delirium. Right lung consolidated at its lower part. Evening temperature i04*6?. Antipyrin gr. 25 in two doses at 8 p.m. At 10 p.m. temperature January 17th.
?
P.M.
103?.
23rd.?Temperature at 10 a.m. 104?. Pulse Respiration rising rapidly at noon 105?.
128.
Warburg's
Tincture in two doses of J oz. each, with a view of bringing down temperature. No effect. No f urther depression produced, but no action on skin. Brandy and ammonia injections alternately every 30 minutes. At 10-30 P.M. the temperature is rising still rapidly. Cold spongings was resorted to, as he was too weak No effect on or the cold bath.
temperature.
At 11 p.m. 11-45 p.m.
[June,
temperature 106"4?.
1888.
Death at
Note.?This was, of course, a very grave case from the as, in spite of antipyretic treatment, the temperature reached a height of 106?Fr. on the second day. Moreover his right lung was nearly consolidated throughout on the 5th day. For the hist two days antipyrin was purposely withheld, as his pulse was too weak to stand any depressant drug. He had small doses of digitalis to keep his cardiac muscle in tone.
beginning,
have been selected, the relative value of Of these kairin the various antipyretics used. is undoubtedly inferior to the others, inasmuch as in large doses it, may produce dangerous depression, and if given, as in tlie ease above reported, in small doses, its effects are uncertain. Moreover, it seems pretty clear that part of its action is to produce disintegration of the blood discs, and it is, therefore, evidently unfitted for
Remarks.?These few
as
showing
continuous
cases
to some extent
use.
Antifebrine is,
no
doubt,superior
both in its superior power of reducing temperature and the absence of after effects. I cannot help thinking, moreover, that the routine in adynamic fevers, more use of antipyrin the severer remittents and enteric especially fever, where the cardiac muscle is so prone to degenerate, must be fraught with danger, whereas if given only when the temperature exceeds a certain height, it is undoubtedly a useful drug, more especially it the cardiac muscle be kept in tone with small doses of digitalis or strophantus, throughout the disease. When an almost cont inuous use of the drug is requisite, I certainly think antifebrine is superior to antipyrin for the reasons stated above. Unfortunately acting as they do directly upon the heart regulating centre in the medulla, or at any rate directly on the central nervous system, rather than on the metabolism of the body, the effects are more or less transitory. of all these
to
antipyrin,
^kaloids
HA.ILEY,
Indian Medical Service.
The 3ome
cases
interest,
narrated below may as
showing
possibly
the action of
be of of
some
MODERN ANTIPYRETICS IN REMITTENT FEVER.
June, 1888.]
169
"
" At 7-30 temperature Autifebrine gr. 10. introduced in remit8-30 100?. At 99?. Considerable temperature tent fever. I may say at once that these cases which were nearly all of the adynamic type, action of skin. No depression of the pulse, or other unpleasant symptom. were treated throughout with small doses of: February 6th.?Temperature 102*6? in the Tinct. digitalis continuously as a cardiac tonic, 10. Temperature fell and, of course, with quinine in the usual doses evening. Antifebrine gr. Profuse sweating. to 99? in two hours. Pulse during the remission, together with stimulants, weaker. only slightly very as I the shall not allude, to all &c., required. February 7tli.? At 2 P. M. a temperature of details of the treatment, but only to that of the 105 '4? was reached. Pul se 100. Respiration pyrexia, the object being to compare the different 40 Antifebrine gr. 7 was adminisminute. per drugs with one another. At 3 p.m. temperature 103-6?. At 4 p.m. Case I. Remittent fever treated by anti- tered. 102-4?. febrine throughout the disease. February 9th.?Temperature 104'6? in the S. Durson Singh, cet. 18, February 25th Antifebrine gr. 10 bringing temadmitted with frontal headache, congested con- morning. to 103'S?. Left lung almost entirely perature junctivas. Temperature 101-2?. Fine crepita- consolidated. tions of middle of left lung and tubular breathFebruary ll?/i.?Temperature in the morning. 105-4?. Is becoming rapidly weaker. Pulse ing 12 at February 27 th?Temperature 103'8?; Cannot swallow. Hypodermic injecrunning. P.M. Antifebrine gr. 10 in brandy ^ oz. ; at 2 tions of ether 3 and brandy alternately. gr. 98-6?. P.M. Profuse sweating. Temperature Enema quinine gr. 30 at midday. Death at Pulse somewhat weaker. First cardiac sound
the
autipyre tics recently
?
not
quite
so
3 p.m.
good.
JBebruary 2Sth.?Temperature
at
103-4? Fr. Antifebrine gr. 7. At 2 At 5 p.m. 99*? 100*8?. perature
February
12 p.m.
M.
P.
the antifebrine certainly caused less and lowered the tempereffectually. This was, however, a very severe The time case, complicated moreover with pneumonia. taken by the antifebrine to lower the temperature was ou The effect on the skin was, an average one to two hours. on the whole, greater than that of the antipyrin. The Note.?In this
Tem- depression ature as
29th.?Temperature kept slightly
case
than the
antipyrin,
above 103? all day. March 2nd.?Complete consolidation of left temperature kept down during a time varying from 5 or lung. At midday temperature 103-4?. Antifeb- 6 to 8 hours. The urine was slightly increased on one rine gr. 7. Temperature fell to 102?. or two occasions when it was measured, but not markedly March 3rd.?Evening temperature 100? only. so. I may add that neither antifebrine not antipyrin has ever caused vomitting or collapse, in these cases. Pulse 100. Respirations 40 per minute*. March 6th.?Temperature normal. Pulse 80. Case No. 3. Remittent fever treated by kairin. Respirations 30 per minute. From this time convalescence set in. S. Nabi Bux, cet. 23, admitted, March 3rd, for Note.?In ibis case antifebrine produced a very marked vomiting, diarrhoea, frontal headache, &c. diminution in temperature on two occasions, producing a Temperature 101-6?. Evening temperature reduction respectively of 5*2? and 4-4? without causing 104-0?. Kairin gr. 7 was given, which brought symptoms of depression otherwise than a slight slowing the to 102? in an hour. temperature in of of the pulse and reduction pulse tension. Given March a kth.?Eight liquid motions since last brandy, it produces very little depressing effect, and small dose of 7 grs. is usually effectual. night. Ordered gallic acid and pulv. doveri 5 of each every quarter hour. Severe remittent fever treat- gr. Case No. 2. consolidation of upper lobe of Well-marked ed first by autipyi'in, subsequently by antifebrio-ht typically pneumonic. Sputum lung. rine. At 3 p.m. temperature 104-8?. Kairin gr. 7 brought at. S. Bunsi Ram, 23, admitted, January it to 103? at 6 P.M. Profuse sweating. Pulse 26th, for headache (frontal,) vomiting, tongue altered. scarcely coated with creamy fur. Temperature on March 5th.?Temperature 104-?. At 1 p.m. admission 104?. Antipyrin in two doses resAt 3 p.m. 103*4 one liquid Kairin gr- 7. pectively of gr. 15 and gr. 10. Temperature stool. 103? after an hour: profuse sweating. March 7th.?At 3 p.m. temperature 103'4?. January 29th.?Temperature at noon At Kairin gr. 7. At 4 p.m. temperature 102-8?. Antipyrin gr. 10. Temperature fell to 101'4 , 10 p.m. 101?. to 99?. and late in the evening
104^.
January 30^.?'Temperature
at
9
10
r.M.
r. m.
rose
gr. 20 in two 100.?
Antipyrin
temperature
104? doses; at to
^
January 31s*.?Evening temperature
Antipyrin
gr. 15.
at
perature 100?. At 10
6
p.m.
P.M.
At 8
103?.
p.m. tem-
temperature 99?.
February 3rd.?Temperature
102? at 6-30 P.M.
March 8th.?Morning
temperature normal;
still very furred in centre, lip and edges clean. Lung clearing up. Convalescence from this date. Case No. 4. Remittent fever of the asthenic type treated by minute doses of Tinct, aconite. Recovery on the 5th day.
tongue
23
THE INDIAN MEDICAL GAZETTE.
170
February 19th.?R. Kandhai Singh, cet. 20, admitted with fluslied face, suffered conjunctiva. Ordered Pulse full and somewhat bounding. diaphoretics. Temperature rose to 105 m the evening. This case did not come under my observation until the morning of the third day. r\
?
?
(February 2). February 20th.?Evening temperature 104?. Diaphoretic mixture continued with quinine during remission. At 10 a.m. temperature 104?. Drop doses of Tinct. aconite ordered every 15 minutes.
11 a.m. at 3 p.m.
102,8? ; The 99*2?. minutes for three in the evening. but not excessive P.M.
temperature 103-8?; at 1 102*6"; at 4r. M. 102*2?;
r.M.
:it 6 aconite was given every 15 Pulse slightly weaker hours. No depression. Skin moist, action.
February 2'2ud.?Morning temperature 102?. Pulse 1'28. Respirations 32. At, 4 a.m. temperature 102?. Drop doses of Tinct. aconite At 1 p.m. temperature every 15 minutes.
103?';
at
2 p.m.
103?; at Aconite given
P.M. 102?. for three hours, beginning O
3 P.M.
102
8?;
at 6
every 15 minutes o'clock. 101 8?. temperature February 23rd.?Morning Tine, aconite in in. doses as before. Atmidda}* temperature 99?; at 6 p.m. 98*8?. J
February
respirations
O
at 4
24 th.?Temperature, normal ; good recovery.
Case No. 5. with antipyrin.
pulse
and
Severe remittent fever treated Death on 8th day.
January 16th.?Shaik Karim, cet. 22, admitted with headache, vomiting, &c. Temperature admission 104?Fr. on Diaphoretic mixture. In the evening the temperature rose to 106?; when antipyrin gr. 20 was given bringing the temperature down to 104?Fr. Pulse 100. Respirations 46 per minute.
Evening temperature at 6-30 106*0?. Antipyrin gr. 10; at 8 P.M. temperature 104?. Tongue dry and cracked. Sordes on teeth. Signs of pneumonia in right lung. 19th.?Evening temperature 105?. Respirations 30. Pulse 110. Antipyrin gr. 10, bringing temperature to 102?. 20th.?Low muttering delirium. Right lung consolidated at its lower part. Evening temperature i04*6?. Antipyrin gr. 25 in two doses at 8 p.m. At 10 p.m. temperature January 17th.
?
P.M.
103?.
23rd.?Temperature at 10 a.m. 104?. Pulse Respiration rising rapidly at noon 105?.
128.
Warburg's
Tincture in two doses of J oz. each, with a view of bringing down temperature. No effect. No f urther depression produced, but no action on skin. Brandy and ammonia injections alternately every 30 minutes. At 10-30 P.M. the temperature is rising still rapidly. Cold spongings was resorted to, as he was too weak No effect on or the cold bath.
temperature.
At 11 p.m. 11-45 p.m.
[June,
temperature 106"4?.
1888.
Death at
Note.?This was, of course, a very grave case from the as, in spite of antipyretic treatment, the temperature reached a height of 106?Fr. on the second day. Moreover his right lung was nearly consolidated throughout on the 5th day. For the hist two days antipyrin was purposely withheld, as his pulse was too weak to stand any depressant drug. He had small doses of digitalis to keep his cardiac muscle in tone.
beginning,
have been selected, the relative value of Of these kairin the various antipyretics used. is undoubtedly inferior to the others, inasmuch as in large doses it, may produce dangerous depression, and if given, as in tlie ease above reported, in small doses, its effects are uncertain. Moreover, it seems pretty clear that part of its action is to produce disintegration of the blood discs, and it is, therefore, evidently unfitted for
Remarks.?These few
as
showing
continuous
cases
to some extent
use.
Antifebrine is,
no
doubt,superior
both in its superior power of reducing temperature and the absence of after effects. I cannot help thinking, moreover, that the routine in adynamic fevers, more use of antipyrin the severer remittents and enteric especially fever, where the cardiac muscle is so prone to degenerate, must be fraught with danger, whereas if given only when the temperature exceeds a certain height, it is undoubtedly a useful drug, more especially it the cardiac muscle be kept in tone with small doses of digitalis or strophantus, throughout the disease. When an almost cont inuous use of the drug is requisite, I certainly think antifebrine is superior to antipyrin for the reasons stated above. Unfortunately acting as they do directly upon the heart regulating centre in the medulla, or at any rate directly on the central nervous system, rather than on the metabolism of the body, the effects are more or less transitory. of all these
to
antipyrin,
^kaloids
