Sfranaadioiw af ^Iqdiqal THE CALCUTTA MEDICAL SOCIETY. The annual meeting of this Society was held at the Medical College on the 13th of January. Dr. Doyal Chundeii Shome in Dr. Cleghorn read the following the chair. paper
011?
ANTIPYRIN.
Gentlemen,
I have thought that a short paper on Antiread before you would lead tlie way to a discussion on its properties and clinical uses, and give an opportunity to those gentlemen present who have had any practical experience of its action in disease to tell us what opinion they have formed of the drug as a therapeutic agent, and what precautions, if any, should be observed in its administration. Before such an audience it is quite unnecessary for me?besides being outside the scope of my paper?to enter into any details regarding the literature of the subject beyond stating that Drs. Penzoldt and Sartorius, who were the first to experiment clinically with the drug, found, that when antipyriu was given in suitable doses, it depresses the temperature for some hours to the extent of several degrees, and that it produces no disturbing symptom except occaThe late Dr. Mahomed sional vomiting. " thought it a remarkable remedy, which seems likely to prove one of the most valuable with In a discussion which we are acquainted." Medical Congress at on the drug before the Copenhagen, there was an unanimous opinion expressed in its favour, and the reports which have from time to time appeared in the Medical Journals are equally favorable. It may be administered with equal efficacy either by the mouth, rectum, or subcutaueously. The doses recommended in the adult being, by the mouth, 20-20-10 or 30-.'50-15 grains at intervals of an hour ; by the rectum, three times these amounts; and subcutaueously, half thequantities. The dose in children is 1? grains for each year of the age of the child. In these doses the temperature occasionally rapidly falls to subnormal, and in all cases the thermometer ought to be used hourly, and when
pyrin
Feb., 1886.]
CLEGHORN ON ANTIPYRIN.
sudden lull takes place, a further dose of the medicine should not be given. It is sometimes accompanied with profuse perspiration, particularly in those cases where the fall of temperature is sudden, which, however, can be prevented by giving a small dose of atropin or agaricin, fifteen minutes before the autipyrin. In weakly patients, I am in the habit of combining digitalis or brandy with each dose of the autipyrin. The vomiting, which in my experience is of comparatively rare occurrence, is not of much consequence, and can be obviated by giving the drug subcutaneously. A remedy possessed of the marvellous power claimed for autipyrin has long been a felt want in Indian practice, where we so frequently meet witli high body temperature, and I feel that I am justified in occupying your valuable time in reading this paper on what may be to us a very important matter, and in asking those of you who have made use of the drug to help us in estimating its true value. Since March last antipyrin has been largely used by the different medical officers attached to the General Hospital, and during the six months I have had charge of the institution, eighteen ounces of the drug have been expended in the wards. From among the patients treated with autipyrin during that period, I have selected these cases, in which the details are sufficiently exact to show clearly the action of the drug in quickly lowering the temperature. The first series of cases are the different varieties of malarial fevers. Had Case No. 1.?A male, aged 28 years. been ill for two days previous to admission. At 5 p. m., on evening of day of admission, temperAt 12-30 ature was 102*8?; at 9 p.m., 103?.
a
m., following day, temperature 106?; at 1 p. m., 30 grains antipyrin given by mouth ; at 2 p.m., temperature 104?; at 3 p.m., a second dose of 30 grains of antipyrin given ; at
p.
temperature 101*8?; at 9-45 p. m., 98?. Had Case No. 2 ?A male, aged 21 years. At been ill for five days before admission. 2-15 p. m., on day of admission, temperature 103? ; at 5 p. m., 102?; at 9 p. m., 103.? At
4 p. m.,
8 a.m., next morning, temperature 100?; at 12-30 p. m., 105? ; at 1 p. m., 30 grains of antipyrin given; at 2 p. m., temperature 104?; at 3 p. m., a second dose of 30 grains of antipyrin
at 5 p.m., temperature 1012?; at 9-30 98?. On foliowi ng morning it rose to p. m., 102?, and then fell to normal, and he was discharged without further rise. Case No. 3.?A male, aged 24 years. Had been ill for seven days previous to admission. At 9-45 a. in., on the second day after admission, temperature 105*8?, when 40 grains antipyrin At 11 a.m., temperature 104?; at were given. It rose again in the evening 12 p.m., 103*8?.
given;
53
104*6?. Next morning, at half-past ten o'clock, temperature 105?, when 40 grains antipyrin were given. At 11-30 a. m temperature 101 *8?, vomited then; at 12-30 p. m., It did not again rise temperature 102 8?. to
,
above 103?. Case No. 4.?A mule, aged 29 years. At 6 p.m., on day of admission, temperature 104-6?, when 30 grains of antipyrin were given ; at 7 p. m., temperature 102*8?, and a second dose of 30 grains of antipyrin given ; at 7-45 p. m., temperature 101 *8? ; at 1J-30 p. m., 99?. No further rise. Case No. 5.?A male, aged 19 years. While under treatment, temperature rose to 104,4?, when 30 grains of antipyrin given. One hour afterwards, temperature fell to 101 *6?, and a second dose of 30grains antipyrin administered. Two and a half hours afterwards temperature became normal. C?se No. 6. A male, aged 23 years. Had been ill for eight days before admission. At 10-30 a.m., on day of admission, temperature was 103?; at 1 m., 103*8?, when 20 grains of ?
j). antipyrin given ; at 3 104*2?, and a second dose
p. m., temperature of 20 grains given ; at 4 p. m., temperature 104*2? ; he was then wet-packed ; and half an hour afterwards temAt 9-30 a. m., perature 103?. temperature 103*4?, when 20 gr ains antipyrin were given ; at midnight* temperature 101*8? At 2 a.m., following morning, temperature was 100*8?, and a second dose of 20 grains of antipyrin given ; at 4 a. m., temperature 99*8?; at 8 a. m., 98? ; and did not again rise. Case No. 7.?A male, aged 18 years. Complicated with enlarged liver. When under treatment, temperature rose at 10-50 a. m. to 104*2?, when 30 grains of antipyrin were given ; at 12 o'clock, temperature 102?, and a second dose of 30 grains of antipyrin given ; at 1 p. in., temperature 100?; and it did not rise afterwards above 102?. Case No. 8.? A male, aged 21 years. Complicated with enlarged liver and spleen. Had been ill for three months. While under treatment, the temperature continued to rise steadily for two days ; and at 3-15 p. m., on third day, it rose to 105*2?, when 30 grains antipyrin
given; at 5 p. m., temperature 103?; at, 10 p. m., 100?. Next evening it again rose to at 8 101?; p.m., temperature 1034?, and 20 At 10 p. m.,
were
temperagrains antipyrin given. The temperature ture 100*48?; midnight 99?, subsequently rose high, antipyrin had little
The man was in f effect in reducing it. aud anaemic and weak state, very ultimately died of the complications. Case No. 9.?A male, aged 21 years. Had been ill far six days before admission. At 11 a.m.,on-day of admission, temperature 103*6?; at 11-15 a. m., 20 grains antipyrin were giv'en ; or
no
THE INDIAN MEDICAL GAZETTE.
54
[Feb.,
1886.
second dose of 20 of normal enteric type under usual remedies. antipyrin given. At 2 p. m., At 10 p. m., on fourth day after admission, temgrains at 10-25 p.m., 30 4 at 102?; p.m., 101*4?; third perature noted at 103 6?; temperature, 11 p.m., temperaAt dose of 20 grains. At 5 p. m., temperature grains antipyrin given. ture 102?; at 2-15 a. m., 100?; at 8-20 a.m., at 98'6?. 9 99*4?; p. m., Case No. 10.?A male, aged 32 years. He 103*4?; 30 grains antipyrin. Vomited at 8-40 At 9-20 a. m., temperature 100*4?. had been ill for some weeks with fever of an a. m. Case No. 15.?A boy, aged 5 years, admitted intermittent type, and had been treated withThe symptoms dated from six At noon, on 21st October. out effect by large doses of quinine. The temperature in the under quinine, temperature 101*6?; at 2 p.m., days previously. He had Next, day, at noon, evening ranged from 103*6? to 105*4?. 101-6? ; at 5 p. m., 101*2?. temperature 102?; at 4 p. m., 103?; at 6 p. m., 5 to 10 grains antipyrin two or three times a 102 2?. Third day, at noon, temperature 101*2?, day with baths, but no exact record was kept 20 grains antipyrin were given. At 12-30 till the 30th October. At 2 p. m., on that day, rose to 106?, when 5 1 grains antip.m., 99*2?; temperature j). m., temperature 100 2?; at At at 1-30 p. m., 98*4?; at 6 p. m., 101*2?; at 7 p. m., pyrin with 20 drops brandy were given. 101*2?; 20 graius of antipyrin were adminis- 2-30 p. m., temperature 104*2?; at 3-15 p. m., At 3 a. m., on 31st tered. At 7-30 p. m., temperature 99 4?. Fourth 102*2?; at 5 p. m., 100?. at 1 p. m.,
of
temperature 103-8?, was
at noon, temperature 99?; at 2 p. m., 99'6?; October, temperature 105?, 5 grains antipyrin At 2-30 p.m., with 20 drops brandy ; at 4 a. m., temperature grains antipyrin given. at 3 99 6?; 20 grains 102*4?; at 6 a.m., temperature 100*2?; at 2 temperature 98*6?; p. m., antipyrin given. At 5 p. in., temperature 99?. p. m., temperature had gradually risen to 105*2?; Antipyrin and quinine combined to keep the 5 grains antipyrin with 20 drops brandy followed by copious perspiration, and temperature at 4 temperature down. fell to 99*4?. 'At, 6 p. m., temperature Case No. 11, aged 41 years, remittent p. m. at 8-20 p. m., 104*8? ; 5 grains shows of what with 100*6?; antipyrin fever, meningitis, symptoms large quantities may be given. When under with brandy. At 9-20 p. m., temperature 103*4? ;
day, 20
10-45 a. in. to 103*4?; grains antipyrin given. At 12-45 ]). m., temperature 101 *6?, second dose given. At 2-45 p. m., temperature 100-6?, third dose given. At 5 p.m., temperature 103?, fourth At 7 p. m., dose of 20 grains administered. temperature 103?, fifth dose of 20 grains given. At 9 p. m., temperature 102?, sixth dose of 20 grains. At 12-30 a. m., temperature 101*6?, seventh dose ; at 2-30 a. m., temperature 100-8?, eighth dose. At 7 a. m., temperature was 98?. Perhaps if the dose had been increased in above case, the temperature might have been lowered treatment, temperature
rose
at
20
sooner.
The next are cases of enteric fever. Case No. 12.?A male, 19 years. When under treatment, temperature rose to 104*4?, when 20 grains antipyrin given. An hour afterwards it fell to 102*6?, second dose of 20 grains. In an hour and a quarter it fell to 100*8?. Case No. 13.?A male, aged 22 years. Ill for 17 days. During treatment, temperature rose at 5 p.m. to 104?; at 8 p.m. temperature was 102 ?, sponged with cold water. At 9-30 ]). m., temperature 102?; again sponged with cold water, 102?. At 10-30 a. m., temperature 102*2?; at 11-30 a.m., 102*8?. At 8 o'clock on
at
10-15 p. in., 102? ; at 12-20 a. m., 105? ; with brandy. At 2 a. in., temperature 102?; at 10 a. m. it rose to 105*4? ; At 11 a. m., 5 grains antipyrin with brandy. temperature 102*4?; at noon, 101? ; at 6 p. m., At 7-30 p. m., 105? ; 5 grains antipyrin. at 8 p. m., 101*2?; and so 102*8?; temperature on till the termination of case in recovery. On 30th October, there appeared a measly looking eruption over whole body, which was noted as fading on 6th November. Case No. 16.?A male, aged 32 years. When I saw him on the second week of the fever, temperature rose to 105? ; 15 grains antipyrin given ; temperature in a few hours fell to normal with excessive perspiration. The next case is one entered as congestive at
5
grains antipyrin
paraplegia.
Case No. 17.?A male, aged 16 years. While under treatment, the temperature rose, one evening, at 5 o'clock, to 103*2? ; after sponging At 1-30 a. m., with cold water it fell to 102*2?. at 5 a.m., 101?; at 1 p.m., 103? ; at 5 p.m., 104*8? ; at 6-30 p.m., 103*8?, At when 30 grains antipyrin were given. 7-30 p. m., temperature 101? ; 9 p. m., 100*4? ; 98? ; it did not again rise.
temperature 102?;
midnight, In the following two following evening temperature was 104?; 8-30 a. m., 40 grains antipyrin. At monalis, the action of
temperature 100? ; at 10-30 a. m., 98-4?; at 1-30 p.m., 98?. Subsequent doses not so successful. Case No. 14.?A male, aged 25 years. Had fever for seven days before admission.. On admission, temperature was 104?, and continued 9-30
a; m.,
cases
of
phthisis pul-
is also well shown. Case No. 18.?A female, aged 18 years, with acute tuberculosis and persistent high evening temperature. At 5 p. m., temperature 104?; 30 grains antipyrin by enema. At 9 p. m., temperature 99*2?. Patient was depressed, and skin cold the
drug
Feb., 1886.]
CLEGHORN ON ANTIPYRIN.
clammy. Subsequent doses of 10 and 15 grains by mouth reduced temperature by two degrees. Case No. 19.?A male, aged 22 years. Cavity in left apex with haemoptysis. Temperature were rose to 103-4?, when 30 grains antipyrin and a three-fourth hours One mouth. given by afterwards, temperature had fallen to 98?. Case No. 20.?In the following case of pleurisy with effusion the effect was less marked ; but the case shows that the drug can be continued in ordinary doses without any bad effect: At 300 grains in four days were administered. 2-30 p.m., temperature 102-2?, 20 grains antipyrin given ; at 5-30 p. m., 100*2?, second dose of 20 grains ; at 7-30 p. m., temperature 99*2?. Next day, at noon, temperature 103?, 20 grains antipyrin given ; at 3 p. m., temperature 102?, second dose of 20 grains; at 5 p.m., temperature 100*8?, third dose of 20 grains; at 7 p. m., Next day, 101?, fourth dose of 20 grains. at 12-40 p. m., temperature 103'6?, 20 grains antipyrin; at 3 p.m., temperature 101-4?, second dose of 20 grains ; at 5 p. tn., temperaat 7 ture 100-2?, third dose of 20 grains; dose of 20 fourth m., 102?, temperature j). grains. Next day, 11a. m., temperature 102?, 20 grains antipyrin; at 1 p. m., temperature
and
103*4?, second dose of 20 grains ; at 3 p. m., temperature 102?, third dose of 20 grains; at 5 p. m., temperature 102-8?, fourth dose of 20 grains ; at 7 p. m., temperature 102'8?, fifth
dose of 20 grains. In all the cases of sunstroke, except the three following, the treatment was so mixed that they are useless for showing the action of
antipyrin.
Case No. 21.?A male, aged 55 years, admitted in an insensible condition, breathing stertorous, and heaving ; and pupils contracted to size of pin-heads. Temperature, on admission, 108-2?. He was put in a bath cooled with ice ; had an iced-water enema ; 10 grains of quinine injected subcutaneously, and 40 grains of antipyrin by mouth, of which lie is said to have swallowed only a portion. Forty-five minutes after these remedies had been applied, the temperature fell to 101 *4?, and rose at 3 p. m. to 102?, when 20
grains antipyrin
were
given
hypodermically.
At 3-30 p.m., temperature 103*4?; at 4 p. m.,
103*6?;
20
grains antipyrin hypodermically
;
at
5-45 p. m., temperature 106?; at 6-10 p. m., 30 grains antipyrin given by mouth ; at 6-30 p. m., 102? ; at 7-30 p. m., 103? ; at 8-30 p. m., 102?, 20 grains antipyrin at 9 p. m. ; at 9-30
p. m., temperature 100?; no further rise. Case No. 22.? A male, aged 36 years. On admission, was at once placed in cold bath ; after
bath, temperature 106?, 20 grains antipyrin given ; 40 minutes after, temperature 101?. Case No. 23.?A male, aged 57 years. Cold bath ou admission. Temperature after bath,
55
half an hour after, In two hours it rose to 104?, antipyrin 20 grains. Forty minutes after it fell to 102*4? ; one hour later it rose to 104?; antipyrin 15 grains; one and half hours after, it fell to 102?, and did not again rise.Case No. 24. A male, aged 38 years. Erysipelas of face and head. Admitted on 24th December last. At 5-15 on evening of 26th December last, his temperature rose to 105*5% 20 grains antipyrin with half an ounce brandy given; at 7-15, temperature 99*6?. On 27th, at
105-2?, antipyrin.20 grains;
temperature 100?.
?
at 10-30 p.m., 102*6?; 12-30 p. m., 103*5? ; 20 grains antipyrin were given, every hour, for four hours; the temperature fell only one degree. At noon on the 28th, the temperature rose to 103-4?, when 30 grains antipyrin given. At 12*30 p. m., temperature 101'6?; at 2-30 p. m. it rose again to 103*6?, 30 grains antipyrin; at 3-30 p.m., 10T60; at 4-30 p. m., lOO'i0 ; at 5-30 p. m., 102?, 15 grains antipyrin ; at 6-30, temperature 99?. At noon next day, temperature 102*6?, 30 grains anti-
8a.m.,temperature 102*5?; at
pyrin ; at 2 antipyrin;
temperature 102*6?, 30 grains temperature 101*6?; at
p.
m.,
at
4 p. m.,
7 p. m., 100? ; no further rise. I think that three cases and the still greater number to whom antipyrin was given at the Hospital, show clearly that, in the doses recommended, and with the necessary precautions, the drug may be administered with perfect
safety. A
remedy which,
in certain cases, may lower
temperature of, say, 105?, suddenly of 97?, with profuse perspiration as an a
to
one
accom-
must in such cases produce a certain amount of collapse or a state of depression This condition, with a cold and clammy skin. was well marked in four of the cases detailed, and in one of them Dr. Harris writes me that he had to give brandy freely; in the other three there was no occasion for alarm. From what I have seen and read in the notes of the practice of my colleagues at the Hospital, and from my own experience of the drug, I begin to have the same confidence in the power of antipyrin to reduce abnormally high temperatures, as I do in opium to produce sleep, and quinine to arrest an intermittent. that the Dr. D. C. Shomb remarked society was under great obligations to Dr. Cleghorn for the most interesting and practical paper he had read, and hoped that some of the members would favour the Society with
paniment,
their experience. Baboo Koylas ChunderBose stated that, for four or five months, he had cautiously given In one trial to antipyrin in several cases. case he had given the drug in 10-grain doses twice daily. The temperature fell from 102^ There wa3 a tendency to 99? under its use. to rise on the third day. The fever went ojr
[Feb.,
THE INDIAN MEDICAL GAZETTE.
56
lor a fortnight, and the patient eventually recovered. In a second case, 10 grains were given, twice a day, for three days, without benefit. The third and fourth cases were of remittent fever; 5 grains-were given twice a day, and then 10 grains for three or four days. The temperature subsided, and the patients recovered. The fifth was also a case of remittent; temperature 107.? Quinine had been tried and failed. Antipyrin was given in 10-grain doses, every three hours, for four or five days. The fever disappeared and did not return ; patient remained dull and stupid for a fortnight. The sixth case was a young Marwari, jet. 23. Jle got fever two days after arrival in Calcutta. He was seen on the third day of fever. He had taken diaphoretic powders without effect; temperature 105?; pain over ensif'orm cartilage. Antipyrin was prescribed in 10-grain doses ever)' two hours, and was given at 1, 3 and 5 At 6 o'clock he was in collapse, and o'clock. died at 7-30. Ao experience of this kind indicated that the medicine was not a safe one. Rai Kanny Loll Dey, Bahadur, had used the drug in a case of intermittent fever of three days' duration without complications ; The five grains were given every four hours. to fell normal 105?, temperature, during its administration, and a return of fever was prevented by giving quinine. In a second case, the temperature was 106?, the drug was given in 5-graiu doses ; it caused nausea and vomiting. The temperature fell, and recovery ensued. A third case of the same kind was similarly treated with similar result. Dk. Sandhrs had used the drug in several cases in hospital with good result, but had unfortunately encountered two fatal cases. One was a Hindu, ajt. 27, suffering under severe fever, with a temperature of 105? and 106? ; 20 grains Five doses were given every second hour. The temperature fell to were administered. 97?, and fatal collapse ensued. The other was the case of a European lady, whose temperature rose to '06? and 107?. After 120 grains of antipyrin had been given in divided doses the temperature fell to 96?, and Dr. Sanders was inclined to death ensued. think that the drug was a dangerous one, and that other safer methods of reducing temperature ought to be resorted to in cases of fever. Dr. R. D. Murray had used antipyrin in the hyperpyrexia of children in 3 or 4-grain doses, repeated every three hours with good effect also in hectic. He had seen a case of Dr. Birch's, a young lady with fever of three or four days' duration, in whom several methods of treatment had been tried without effect. Antipyrin was used with excellent result. .
188(7.
Dit. A. Mitka stated tliat, having heard that large doses of the drug caused fevei', he had taken 50 grains that morning. TemperaHe vomited once, ture rose to 99? in an hour. and felt giddy and nauseated all day. Dr. Cleghorn remarked, that the drug was evidently unsuited for cases with severe visceral complications, and that its effects must be narrowly watched. He hud received a letter from Dr. McConnell, containing valuable remarks on the subject, which he would read : " I have used anlipyrin for the last eight or nine months, giving it in doses varying from 10 to 30grains. In adults, for enteric and remittent fevers, I find the best results from 20 to 30 grains given every hour for three doses, and find these rarely fail to reduce temperature to normal and often subnormal. But the effect is evanescent, and, as a rule, cannot be counted on to last over six hours, and often not for three or four. " It produces a good deal of depression in nine out of ten cases, with profuse diaphoresis. The depression may be counteracted by prescribing ammonia or ammonia and digitalis with the antipyrin, or by giving (when not contra-indicated) a small quantity of brandy with the last When the profuse sweating is or third dose. I have found one drop or minim of objectionable, dose of antipyrin couneach with Liq. atropije teract this, and without influencing the fall in temperature, so that the latter cannot be due entirely to the sweating and evaporation from the skin. " I have given it to patients of all ages, from infants upwards, and never observed alarming effects when guarded in the way or untoward I have at present under my care a indicated. case of spinal injury (probably acute hasmorrhagic myelitis), in which very high temperatures have been maintained for over a month, for which all kinds of antipyretics have been tried, including small and very large doses of quinine, and in which I am able to control the temperature and keep it below 102?F. throughout the 24 hours only by means of antipyrin. " I have no belief in it as an antiperiodic, and have never known it to cure any case of malarial fever, but in remittents it serves to rapidly, and so enables bring down temperature ' when otherwise we be to in,' the quinine put would not be able to do so." The discussion was at this stage adjourned. Dr. Sanders exhibited
a case
of
NiEVOID TUMOUR OF THE OCCIPUT,
removal
was followed by remarkable depression ; the details are as follows :? Rosomoy Banerjee, a Hindu boy, aged 14
whose
nervous
years, was admitted on the 24t.h December 1885, with a nasvoid tumour over the back of his head. The history was, that he had a very small tumour over the back of his head at birth,
Feb., 1886.]
CONCUSSION?SARCOMA.
The which has been slowly increasing in size. tumour was about the size of an orange, and lobulated, and situated over the occipital proIt was soft, minence by a narrow peduncle. in size firm and reducible movable, by pressure It was not painful, and no hair was over it. seen to grow over it. The next morning he was put under chloroform, and the tumour was pared off after its peduncle had been ligatured in two halves. No bleeding from any vessel was observed, but slight, oozing ensued, which was stopped by tlie application of styptic colloid and dry lint. It. was dressed with Gramgee's tissue and carbolized Extreme debility followed the removal of tow. the tumour, and lasted for one day. The tumour, on dissection, was found to consist of fibrous and vascular tissues. The ligature came off on the 3rd January, and the ulcerated surface is healing gradually. ,
Dr. Sanders also exhibited CONCUSSION
OF
a case
of
THE BIIAIN,
by compression, in which recovery eventually took place. The following notes
followed
contain the main incidents of the case. Laljee Misser, a Hindu male, aged 20 years, admitted into the Hospital 011 the 24th ?was August 1885, at 2 p. M., for concussion of brain, left, side of head, a lacerated wound over the a contusion over its posterior part, a small lacerated wound over the right side of forehead, and superficial abrasions here and there over the body. These injuries were caused by a fall from On admission the deck of a ship into its hold. he was found pretty sensible, but dull; answering questions stammeringly ; could walk, but his gait was unsteady ; his pupils were normal, and responded to the action of light ; had no bleeding from the nose, mouth or ears; he had no perfect, control over his limbs, and his upper right eyelid was much swollen and ecchymosed ; pulse was small, feeble, and regular. In the evening he was insensible, and did not answer when called.; his upper extremities were crossed over the chest, and his pulse was small, slow, but regular. The following morning he became a little restless and more insensible; his pupils were slightly dilated, but responded to the action of light; pulse became a little full, and lie passed water in his bed clothes. Insensibility was the same, and the pulse became very small and slow, but regular till the morning of the 27th, when he was a little sensible, and paralysis of the left extremities was observed ; the lett pupil was normal, and the right one slightly dilated; passed one stool after enema. He had a little evening rise of temperature since evening of his admission till the 28th August, but the temperature was never higher than 101? F.
57
On 31st August a big blister was observed the inner side of the ball of the great toe, and on removing it the superficial tissues were found sloughy. Swelling and ecchymosis of the right upper eyelid gradually passed off, and ptosis of thislid was first observed on the 5th September, but the pupil became normal. Paralysis of the left limbs continued the same till the 2nd November, when it was first observed that he could move his paralyzed limbs a little. Improvement in the paralyzed limbs progressed gradually, and he could walk with help on the 21st. November, and a few days afterwards he was able to walk with the help of a stick. Ptosis has also gradually passed off. Now he walks about without the help of a stick, but has to drag his left leg a little. over
Dr. McLicod showed two SARCOMA
OF
specimens
of
THE
FOREARM, remarkable on account of the similarity of the tumours, their simultaneous treatment, and the satisfactory result of aseptic amputation. The following notes have been furnished by Assistant Surgeon Khagendra Nath Sen : I. G. C, Banerjea,adult,Hindu, male,get. 21, admitted, with sarcoma of the left forearm, on the 27th November 1885 ; duration one year. The tumour is spheroidal in shape, about the size of a child's head. It extends from the middle of the forearm to the middle of the palm of the hand, anteriorly as well as posteriorly. There are some prominent veins on its surface, lie can move his fingers slightly. The left axillary glands slightly enlarged ; no history of syphilis or gonorrhoea; all systems normal. Operation, 2nd December 1885.?Chloroform administered, and the left forearm amputated about its middle by the modified circular The flaps were brought together by method. two metallic and some horse-hair stitches; a drainage tube inserted. Dressed with iodoform and boraeic and bichloride gauze. Subsequent progress.?On the 8th December, the drainage tube and the wire stitches removed altogether, and the flaps seem to have All the horse-hair stitches reunited well. moved on the 13th December 1885. On the 26th, all the wounds seemed to have healed up except a small sore in the centre. Dressings changed eight times altogether. Left the Hoscured, on the 31st December 1885. which
were
-
?
pital^
Golam Safdar, adult,
Mahomedan, male, occupation a writer, admitted with sarcoma of right forearm ; duration five years; spheroidal, about the size of a melon, and exII.
a3t.
27, by
from the middle of the forearm to the wrist joint, anteriorly and postriorly, from the middle of the forearm to the upper ends of the
tending
THE INDIAN" MEDICAL- GAZETTE.
58
[Feb.,
1886.
111. Mr. E. S., railway engineer,European, metacarpal bones, skin over the tumour moveable, and some prominent veins on its surface. male, admitted with the right malleolus comBesides, some fluctuating points visible oil its pletely knocked off, and with lacerated Avounds surface.
over
both external and internal malleoli.
This
Operation, 16th December 1885.?Chloroform accident was caused by the foot being caught administered, forearm amputated about its between the spokes of a wheel and the platform middle by the modified circular method; eight of a trolly in motion. Admitted, on the 12th bleeding vessels tied. The flaps were united November, six hours after the accident. by th ree wire stitches and some horse-hair Dressed with iodoform and bichloride gauze, stitches; a drainage tube inserted; dressed and the leg put on a Mclntyre splint. with iodoform and bichloride gauze. Subsequent progress.?On the 14th the temSubsequent progress.?The patient left the perature rose to 101? F., in the evening, his Hospital 24 days after admission ; dressings bowels being confined. This was the only changed seven times altogether. On the 22nd occasion on which a rise was observed. At .December, the drainage tube, and on the 26th, first the dressings were changed every third the wire stitches, removed. On the 4th January day; the deep dressings being left untouched. 1886, the flaps were found to have united, a At the fifth dressing, a small slough was noticed small
sinus
remaining at one corner. 4th January 1886.
Dis-
charged, cured,
Dr. McLeod also related three cases of COMPOUND FRACTURE, which had recently been treated with marked success by means of antiseptics. I. Shomsere Beg, adult, Mahomedan, male, ajt. 29, admitted with subcoracoid dislocation of the right humerus and fracture (compound) the surgical neck of the humerus, caused through O by a fall from a horse whilst riding on the 1st December 1885. There is a small valvular opening on the inner side of the arm at its upper part, communicating with the cavity of the fracture. ls? December i885. Dislocation reduced by manipulation and extension, and the fracture put up in splints ; wound dressed antiseptically. On the 8th December, the splints were removed, and the valvular opening was found to have The fracture was agaiu put up in closed. and guttapercha splints. Discharged, angular cured, 26th December 1885. II. Bhartu, adult, Hindu, male, ajt. 30, admitted on the 11th December 1885 with compound fracture of the thigh about its middle. States that he was raising an iron beam on to the roof of a two-storied house, when accidentally the scaffold on which he was standing gave way, and he fell down with the beam, which struck him on his right thigh. There is one lacerated wound on the anterior aspect of the thigh, 2 inches long and 1 inch broad, and another punctured wound on the posterior aspect bleeding freely, both leading to the cavity of the fracture. Is quite conscious; pulse moderately full. ;
O
?
Subsequent progress.?Dressed antiseptically
dressings changed
Baboo Jogendra Nath Ghose showed several specimens found in the dissecting rooms of the Sealdah School: An undeveloped kidney in an adult 1. male, the opposite one being larger than usual. A portion of the head of the femur, 2. which was found loose in the acetabulum having been broken off during life. The cartilage showed signs of erosion. A neuroma of the median nerve3. Baboo Devendra Nath Dey showed 1. A LARGE RENAL CALCULUS, weighing drs., which was found in the college dissecting rooms. The kidney was disorganized. A specimen of Hodgkin's disease of 2. the SPLEEN. The Office Bearers for 1886 were then elected by ballot with the following result:? President.
Dr. D. O'C.
;
and after the seventh dressing, which took place on the 1 st January 1886, the posterior wound was found to have closed up entirely, and the anterior wound to be cicatrizing rapidly. From the 1st to the 13th instant, dressings changed only twice. (The wounds have since healed and the fracture is undergoing satisfactory repair.)
the outer wound.
From the 1st December every fourth day till his discharge on the 5th January 1886. The slough gradually separated, and the patient left the hospital with a small linear sore on the inner malleolus, and two small sores on the outer malleolus. He has written to say that the wounds have healed, and that lie has good motion at the ankle-joint. over
1
Raye.
Vice-Presidents. Dr. R. C. Sanders. Baboo Lall Madhub Mookerjee, L.M.S. Secretaries. Dr. K. McLeod. Moulvi Zuheroodeen Ahmed, L.M.S. Treasurer. Baboo Mahendra Nath Gupta, L.M.S. Executive Committee. Dr. J. M. Coates. Baboo Doyal Chunder Shome, M.B. Dr. B. Harvey. Baboo Rakhal Das Ghose, L.M.S. Dr. E. Chambers. Baboo Devendra Nath Dey, L.M.S.
011?
ANTIPYRIN.
Gentlemen,
I have thought that a short paper on Antiread before you would lead tlie way to a discussion on its properties and clinical uses, and give an opportunity to those gentlemen present who have had any practical experience of its action in disease to tell us what opinion they have formed of the drug as a therapeutic agent, and what precautions, if any, should be observed in its administration. Before such an audience it is quite unnecessary for me?besides being outside the scope of my paper?to enter into any details regarding the literature of the subject beyond stating that Drs. Penzoldt and Sartorius, who were the first to experiment clinically with the drug, found, that when antipyriu was given in suitable doses, it depresses the temperature for some hours to the extent of several degrees, and that it produces no disturbing symptom except occaThe late Dr. Mahomed sional vomiting. " thought it a remarkable remedy, which seems likely to prove one of the most valuable with In a discussion which we are acquainted." Medical Congress at on the drug before the Copenhagen, there was an unanimous opinion expressed in its favour, and the reports which have from time to time appeared in the Medical Journals are equally favorable. It may be administered with equal efficacy either by the mouth, rectum, or subcutaueously. The doses recommended in the adult being, by the mouth, 20-20-10 or 30-.'50-15 grains at intervals of an hour ; by the rectum, three times these amounts; and subcutaueously, half thequantities. The dose in children is 1? grains for each year of the age of the child. In these doses the temperature occasionally rapidly falls to subnormal, and in all cases the thermometer ought to be used hourly, and when
pyrin
Feb., 1886.]
CLEGHORN ON ANTIPYRIN.
sudden lull takes place, a further dose of the medicine should not be given. It is sometimes accompanied with profuse perspiration, particularly in those cases where the fall of temperature is sudden, which, however, can be prevented by giving a small dose of atropin or agaricin, fifteen minutes before the autipyrin. In weakly patients, I am in the habit of combining digitalis or brandy with each dose of the autipyrin. The vomiting, which in my experience is of comparatively rare occurrence, is not of much consequence, and can be obviated by giving the drug subcutaneously. A remedy possessed of the marvellous power claimed for autipyrin has long been a felt want in Indian practice, where we so frequently meet witli high body temperature, and I feel that I am justified in occupying your valuable time in reading this paper on what may be to us a very important matter, and in asking those of you who have made use of the drug to help us in estimating its true value. Since March last antipyrin has been largely used by the different medical officers attached to the General Hospital, and during the six months I have had charge of the institution, eighteen ounces of the drug have been expended in the wards. From among the patients treated with autipyrin during that period, I have selected these cases, in which the details are sufficiently exact to show clearly the action of the drug in quickly lowering the temperature. The first series of cases are the different varieties of malarial fevers. Had Case No. 1.?A male, aged 28 years. been ill for two days previous to admission. At 5 p. m., on evening of day of admission, temperAt 12-30 ature was 102*8?; at 9 p.m., 103?.
a
m., following day, temperature 106?; at 1 p. m., 30 grains antipyrin given by mouth ; at 2 p.m., temperature 104?; at 3 p.m., a second dose of 30 grains of antipyrin given ; at
p.
temperature 101*8?; at 9-45 p. m., 98?. Had Case No. 2 ?A male, aged 21 years. At been ill for five days before admission. 2-15 p. m., on day of admission, temperature 103? ; at 5 p. m., 102?; at 9 p. m., 103.? At
4 p. m.,
8 a.m., next morning, temperature 100?; at 12-30 p. m., 105? ; at 1 p. m., 30 grains of antipyrin given; at 2 p. m., temperature 104?; at 3 p. m., a second dose of 30 grains of antipyrin
at 5 p.m., temperature 1012?; at 9-30 98?. On foliowi ng morning it rose to p. m., 102?, and then fell to normal, and he was discharged without further rise. Case No. 3.?A male, aged 24 years. Had been ill for seven days previous to admission. At 9-45 a. in., on the second day after admission, temperature 105*8?, when 40 grains antipyrin At 11 a.m., temperature 104?; at were given. It rose again in the evening 12 p.m., 103*8?.
given;
53
104*6?. Next morning, at half-past ten o'clock, temperature 105?, when 40 grains antipyrin were given. At 11-30 a. m temperature 101 *8?, vomited then; at 12-30 p. m., It did not again rise temperature 102 8?. to
,
above 103?. Case No. 4.?A mule, aged 29 years. At 6 p.m., on day of admission, temperature 104-6?, when 30 grains of antipyrin were given ; at 7 p. m., temperature 102*8?, and a second dose of 30 grains of antipyrin given ; at 7-45 p. m., temperature 101 *8? ; at 1J-30 p. m., 99?. No further rise. Case No. 5.?A male, aged 19 years. While under treatment, temperature rose to 104,4?, when 30 grains of antipyrin given. One hour afterwards, temperature fell to 101 *6?, and a second dose of 30grains antipyrin administered. Two and a half hours afterwards temperature became normal. C?se No. 6. A male, aged 23 years. Had been ill for eight days before admission. At 10-30 a.m., on day of admission, temperature was 103?; at 1 m., 103*8?, when 20 grains of ?
j). antipyrin given ; at 3 104*2?, and a second dose
p. m., temperature of 20 grains given ; at 4 p. m., temperature 104*2? ; he was then wet-packed ; and half an hour afterwards temAt 9-30 a. m., perature 103?. temperature 103*4?, when 20 gr ains antipyrin were given ; at midnight* temperature 101*8? At 2 a.m., following morning, temperature was 100*8?, and a second dose of 20 grains of antipyrin given ; at 4 a. m., temperature 99*8?; at 8 a. m., 98? ; and did not again rise. Case No. 7.?A male, aged 18 years. Complicated with enlarged liver. When under treatment, temperature rose at 10-50 a. m. to 104*2?, when 30 grains of antipyrin were given ; at 12 o'clock, temperature 102?, and a second dose of 30 grains of antipyrin given ; at 1 p. in., temperature 100?; and it did not rise afterwards above 102?. Case No. 8.? A male, aged 21 years. Complicated with enlarged liver and spleen. Had been ill for three months. While under treatment, the temperature continued to rise steadily for two days ; and at 3-15 p. m., on third day, it rose to 105*2?, when 30 grains antipyrin
given; at 5 p. m., temperature 103?; at, 10 p. m., 100?. Next evening it again rose to at 8 101?; p.m., temperature 1034?, and 20 At 10 p. m.,
were
temperagrains antipyrin given. The temperature ture 100*48?; midnight 99?, subsequently rose high, antipyrin had little
The man was in f effect in reducing it. aud anaemic and weak state, very ultimately died of the complications. Case No. 9.?A male, aged 21 years. Had been ill far six days before admission. At 11 a.m.,on-day of admission, temperature 103*6?; at 11-15 a. m., 20 grains antipyrin were giv'en ; or
no
THE INDIAN MEDICAL GAZETTE.
54
[Feb.,
1886.
second dose of 20 of normal enteric type under usual remedies. antipyrin given. At 2 p. m., At 10 p. m., on fourth day after admission, temgrains at 10-25 p.m., 30 4 at 102?; p.m., 101*4?; third perature noted at 103 6?; temperature, 11 p.m., temperaAt dose of 20 grains. At 5 p. m., temperature grains antipyrin given. ture 102?; at 2-15 a. m., 100?; at 8-20 a.m., at 98'6?. 9 99*4?; p. m., Case No. 10.?A male, aged 32 years. He 103*4?; 30 grains antipyrin. Vomited at 8-40 At 9-20 a. m., temperature 100*4?. had been ill for some weeks with fever of an a. m. Case No. 15.?A boy, aged 5 years, admitted intermittent type, and had been treated withThe symptoms dated from six At noon, on 21st October. out effect by large doses of quinine. The temperature in the under quinine, temperature 101*6?; at 2 p.m., days previously. He had Next, day, at noon, evening ranged from 103*6? to 105*4?. 101-6? ; at 5 p. m., 101*2?. temperature 102?; at 4 p. m., 103?; at 6 p. m., 5 to 10 grains antipyrin two or three times a 102 2?. Third day, at noon, temperature 101*2?, day with baths, but no exact record was kept 20 grains antipyrin were given. At 12-30 till the 30th October. At 2 p. m., on that day, rose to 106?, when 5 1 grains antip.m., 99*2?; temperature j). m., temperature 100 2?; at At at 1-30 p. m., 98*4?; at 6 p. m., 101*2?; at 7 p. m., pyrin with 20 drops brandy were given. 101*2?; 20 graius of antipyrin were adminis- 2-30 p. m., temperature 104*2?; at 3-15 p. m., At 3 a. m., on 31st tered. At 7-30 p. m., temperature 99 4?. Fourth 102*2?; at 5 p. m., 100?. at 1 p. m.,
of
temperature 103-8?, was
at noon, temperature 99?; at 2 p. m., 99'6?; October, temperature 105?, 5 grains antipyrin At 2-30 p.m., with 20 drops brandy ; at 4 a. m., temperature grains antipyrin given. at 3 99 6?; 20 grains 102*4?; at 6 a.m., temperature 100*2?; at 2 temperature 98*6?; p. m., antipyrin given. At 5 p. in., temperature 99?. p. m., temperature had gradually risen to 105*2?; Antipyrin and quinine combined to keep the 5 grains antipyrin with 20 drops brandy followed by copious perspiration, and temperature at 4 temperature down. fell to 99*4?. 'At, 6 p. m., temperature Case No. 11, aged 41 years, remittent p. m. at 8-20 p. m., 104*8? ; 5 grains shows of what with 100*6?; antipyrin fever, meningitis, symptoms large quantities may be given. When under with brandy. At 9-20 p. m., temperature 103*4? ;
day, 20
10-45 a. in. to 103*4?; grains antipyrin given. At 12-45 ]). m., temperature 101 *6?, second dose given. At 2-45 p. m., temperature 100-6?, third dose given. At 5 p.m., temperature 103?, fourth At 7 p. m., dose of 20 grains administered. temperature 103?, fifth dose of 20 grains given. At 9 p. m., temperature 102?, sixth dose of 20 grains. At 12-30 a. m., temperature 101*6?, seventh dose ; at 2-30 a. m., temperature 100-8?, eighth dose. At 7 a. m., temperature was 98?. Perhaps if the dose had been increased in above case, the temperature might have been lowered treatment, temperature
rose
at
20
sooner.
The next are cases of enteric fever. Case No. 12.?A male, 19 years. When under treatment, temperature rose to 104*4?, when 20 grains antipyrin given. An hour afterwards it fell to 102*6?, second dose of 20 grains. In an hour and a quarter it fell to 100*8?. Case No. 13.?A male, aged 22 years. Ill for 17 days. During treatment, temperature rose at 5 p.m. to 104?; at 8 p.m. temperature was 102 ?, sponged with cold water. At 9-30 ]). m., temperature 102?; again sponged with cold water, 102?. At 10-30 a. m., temperature 102*2?; at 11-30 a.m., 102*8?. At 8 o'clock on
at
10-15 p. in., 102? ; at 12-20 a. m., 105? ; with brandy. At 2 a. in., temperature 102?; at 10 a. m. it rose to 105*4? ; At 11 a. m., 5 grains antipyrin with brandy. temperature 102*4?; at noon, 101? ; at 6 p. m., At 7-30 p. m., 105? ; 5 grains antipyrin. at 8 p. m., 101*2?; and so 102*8?; temperature on till the termination of case in recovery. On 30th October, there appeared a measly looking eruption over whole body, which was noted as fading on 6th November. Case No. 16.?A male, aged 32 years. When I saw him on the second week of the fever, temperature rose to 105? ; 15 grains antipyrin given ; temperature in a few hours fell to normal with excessive perspiration. The next case is one entered as congestive at
5
grains antipyrin
paraplegia.
Case No. 17.?A male, aged 16 years. While under treatment, the temperature rose, one evening, at 5 o'clock, to 103*2? ; after sponging At 1-30 a. m., with cold water it fell to 102*2?. at 5 a.m., 101?; at 1 p.m., 103? ; at 5 p.m., 104*8? ; at 6-30 p.m., 103*8?, At when 30 grains antipyrin were given. 7-30 p. m., temperature 101? ; 9 p. m., 100*4? ; 98? ; it did not again rise.
temperature 102?;
midnight, In the following two following evening temperature was 104?; 8-30 a. m., 40 grains antipyrin. At monalis, the action of
temperature 100? ; at 10-30 a. m., 98-4?; at 1-30 p.m., 98?. Subsequent doses not so successful. Case No. 14.?A male, aged 25 years. Had fever for seven days before admission.. On admission, temperature was 104?, and continued 9-30
a; m.,
cases
of
phthisis pul-
is also well shown. Case No. 18.?A female, aged 18 years, with acute tuberculosis and persistent high evening temperature. At 5 p. m., temperature 104?; 30 grains antipyrin by enema. At 9 p. m., temperature 99*2?. Patient was depressed, and skin cold the
drug
Feb., 1886.]
CLEGHORN ON ANTIPYRIN.
clammy. Subsequent doses of 10 and 15 grains by mouth reduced temperature by two degrees. Case No. 19.?A male, aged 22 years. Cavity in left apex with haemoptysis. Temperature were rose to 103-4?, when 30 grains antipyrin and a three-fourth hours One mouth. given by afterwards, temperature had fallen to 98?. Case No. 20.?In the following case of pleurisy with effusion the effect was less marked ; but the case shows that the drug can be continued in ordinary doses without any bad effect: At 300 grains in four days were administered. 2-30 p.m., temperature 102-2?, 20 grains antipyrin given ; at 5-30 p. m., 100*2?, second dose of 20 grains ; at 7-30 p. m., temperature 99*2?. Next day, at noon, temperature 103?, 20 grains antipyrin given ; at 3 p. m., temperature 102?, second dose of 20 grains; at 5 p.m., temperature 100*8?, third dose of 20 grains; at 7 p. m., Next day, 101?, fourth dose of 20 grains. at 12-40 p. m., temperature 103'6?, 20 grains antipyrin; at 3 p.m., temperature 101-4?, second dose of 20 grains ; at 5 p. tn., temperaat 7 ture 100-2?, third dose of 20 grains; dose of 20 fourth m., 102?, temperature j). grains. Next day, 11a. m., temperature 102?, 20 grains antipyrin; at 1 p. m., temperature
and
103*4?, second dose of 20 grains ; at 3 p. m., temperature 102?, third dose of 20 grains; at 5 p. m., temperature 102-8?, fourth dose of 20 grains ; at 7 p. m., temperature 102'8?, fifth
dose of 20 grains. In all the cases of sunstroke, except the three following, the treatment was so mixed that they are useless for showing the action of
antipyrin.
Case No. 21.?A male, aged 55 years, admitted in an insensible condition, breathing stertorous, and heaving ; and pupils contracted to size of pin-heads. Temperature, on admission, 108-2?. He was put in a bath cooled with ice ; had an iced-water enema ; 10 grains of quinine injected subcutaneously, and 40 grains of antipyrin by mouth, of which lie is said to have swallowed only a portion. Forty-five minutes after these remedies had been applied, the temperature fell to 101 *4?, and rose at 3 p. m. to 102?, when 20
grains antipyrin
were
given
hypodermically.
At 3-30 p.m., temperature 103*4?; at 4 p. m.,
103*6?;
20
grains antipyrin hypodermically
;
at
5-45 p. m., temperature 106?; at 6-10 p. m., 30 grains antipyrin given by mouth ; at 6-30 p. m., 102? ; at 7-30 p. m., 103? ; at 8-30 p. m., 102?, 20 grains antipyrin at 9 p. m. ; at 9-30
p. m., temperature 100?; no further rise. Case No. 22.? A male, aged 36 years. On admission, was at once placed in cold bath ; after
bath, temperature 106?, 20 grains antipyrin given ; 40 minutes after, temperature 101?. Case No. 23.?A male, aged 57 years. Cold bath ou admission. Temperature after bath,
55
half an hour after, In two hours it rose to 104?, antipyrin 20 grains. Forty minutes after it fell to 102*4? ; one hour later it rose to 104?; antipyrin 15 grains; one and half hours after, it fell to 102?, and did not again rise.Case No. 24. A male, aged 38 years. Erysipelas of face and head. Admitted on 24th December last. At 5-15 on evening of 26th December last, his temperature rose to 105*5% 20 grains antipyrin with half an ounce brandy given; at 7-15, temperature 99*6?. On 27th, at
105-2?, antipyrin.20 grains;
temperature 100?.
?
at 10-30 p.m., 102*6?; 12-30 p. m., 103*5? ; 20 grains antipyrin were given, every hour, for four hours; the temperature fell only one degree. At noon on the 28th, the temperature rose to 103-4?, when 30 grains antipyrin given. At 12*30 p. m., temperature 101'6?; at 2-30 p. m. it rose again to 103*6?, 30 grains antipyrin; at 3-30 p.m., 10T60; at 4-30 p. m., lOO'i0 ; at 5-30 p. m., 102?, 15 grains antipyrin ; at 6-30, temperature 99?. At noon next day, temperature 102*6?, 30 grains anti-
8a.m.,temperature 102*5?; at
pyrin ; at 2 antipyrin;
temperature 102*6?, 30 grains temperature 101*6?; at
p.
m.,
at
4 p. m.,
7 p. m., 100? ; no further rise. I think that three cases and the still greater number to whom antipyrin was given at the Hospital, show clearly that, in the doses recommended, and with the necessary precautions, the drug may be administered with perfect
safety. A
remedy which,
in certain cases, may lower
temperature of, say, 105?, suddenly of 97?, with profuse perspiration as an a
to
one
accom-
must in such cases produce a certain amount of collapse or a state of depression This condition, with a cold and clammy skin. was well marked in four of the cases detailed, and in one of them Dr. Harris writes me that he had to give brandy freely; in the other three there was no occasion for alarm. From what I have seen and read in the notes of the practice of my colleagues at the Hospital, and from my own experience of the drug, I begin to have the same confidence in the power of antipyrin to reduce abnormally high temperatures, as I do in opium to produce sleep, and quinine to arrest an intermittent. that the Dr. D. C. Shomb remarked society was under great obligations to Dr. Cleghorn for the most interesting and practical paper he had read, and hoped that some of the members would favour the Society with
paniment,
their experience. Baboo Koylas ChunderBose stated that, for four or five months, he had cautiously given In one trial to antipyrin in several cases. case he had given the drug in 10-grain doses twice daily. The temperature fell from 102^ There wa3 a tendency to 99? under its use. to rise on the third day. The fever went ojr
[Feb.,
THE INDIAN MEDICAL GAZETTE.
56
lor a fortnight, and the patient eventually recovered. In a second case, 10 grains were given, twice a day, for three days, without benefit. The third and fourth cases were of remittent fever; 5 grains-were given twice a day, and then 10 grains for three or four days. The temperature subsided, and the patients recovered. The fifth was also a case of remittent; temperature 107.? Quinine had been tried and failed. Antipyrin was given in 10-grain doses, every three hours, for four or five days. The fever disappeared and did not return ; patient remained dull and stupid for a fortnight. The sixth case was a young Marwari, jet. 23. Jle got fever two days after arrival in Calcutta. He was seen on the third day of fever. He had taken diaphoretic powders without effect; temperature 105?; pain over ensif'orm cartilage. Antipyrin was prescribed in 10-grain doses ever)' two hours, and was given at 1, 3 and 5 At 6 o'clock he was in collapse, and o'clock. died at 7-30. Ao experience of this kind indicated that the medicine was not a safe one. Rai Kanny Loll Dey, Bahadur, had used the drug in a case of intermittent fever of three days' duration without complications ; The five grains were given every four hours. to fell normal 105?, temperature, during its administration, and a return of fever was prevented by giving quinine. In a second case, the temperature was 106?, the drug was given in 5-graiu doses ; it caused nausea and vomiting. The temperature fell, and recovery ensued. A third case of the same kind was similarly treated with similar result. Dk. Sandhrs had used the drug in several cases in hospital with good result, but had unfortunately encountered two fatal cases. One was a Hindu, ajt. 27, suffering under severe fever, with a temperature of 105? and 106? ; 20 grains Five doses were given every second hour. The temperature fell to were administered. 97?, and fatal collapse ensued. The other was the case of a European lady, whose temperature rose to '06? and 107?. After 120 grains of antipyrin had been given in divided doses the temperature fell to 96?, and Dr. Sanders was inclined to death ensued. think that the drug was a dangerous one, and that other safer methods of reducing temperature ought to be resorted to in cases of fever. Dr. R. D. Murray had used antipyrin in the hyperpyrexia of children in 3 or 4-grain doses, repeated every three hours with good effect also in hectic. He had seen a case of Dr. Birch's, a young lady with fever of three or four days' duration, in whom several methods of treatment had been tried without effect. Antipyrin was used with excellent result. .
188(7.
Dit. A. Mitka stated tliat, having heard that large doses of the drug caused fevei', he had taken 50 grains that morning. TemperaHe vomited once, ture rose to 99? in an hour. and felt giddy and nauseated all day. Dr. Cleghorn remarked, that the drug was evidently unsuited for cases with severe visceral complications, and that its effects must be narrowly watched. He hud received a letter from Dr. McConnell, containing valuable remarks on the subject, which he would read : " I have used anlipyrin for the last eight or nine months, giving it in doses varying from 10 to 30grains. In adults, for enteric and remittent fevers, I find the best results from 20 to 30 grains given every hour for three doses, and find these rarely fail to reduce temperature to normal and often subnormal. But the effect is evanescent, and, as a rule, cannot be counted on to last over six hours, and often not for three or four. " It produces a good deal of depression in nine out of ten cases, with profuse diaphoresis. The depression may be counteracted by prescribing ammonia or ammonia and digitalis with the antipyrin, or by giving (when not contra-indicated) a small quantity of brandy with the last When the profuse sweating is or third dose. I have found one drop or minim of objectionable, dose of antipyrin couneach with Liq. atropije teract this, and without influencing the fall in temperature, so that the latter cannot be due entirely to the sweating and evaporation from the skin. " I have given it to patients of all ages, from infants upwards, and never observed alarming effects when guarded in the way or untoward I have at present under my care a indicated. case of spinal injury (probably acute hasmorrhagic myelitis), in which very high temperatures have been maintained for over a month, for which all kinds of antipyretics have been tried, including small and very large doses of quinine, and in which I am able to control the temperature and keep it below 102?F. throughout the 24 hours only by means of antipyrin. " I have no belief in it as an antiperiodic, and have never known it to cure any case of malarial fever, but in remittents it serves to rapidly, and so enables bring down temperature ' when otherwise we be to in,' the quinine put would not be able to do so." The discussion was at this stage adjourned. Dr. Sanders exhibited
a case
of
NiEVOID TUMOUR OF THE OCCIPUT,
removal
was followed by remarkable depression ; the details are as follows :? Rosomoy Banerjee, a Hindu boy, aged 14
whose
nervous
years, was admitted on the 24t.h December 1885, with a nasvoid tumour over the back of his head. The history was, that he had a very small tumour over the back of his head at birth,
Feb., 1886.]
CONCUSSION?SARCOMA.
The which has been slowly increasing in size. tumour was about the size of an orange, and lobulated, and situated over the occipital proIt was soft, minence by a narrow peduncle. in size firm and reducible movable, by pressure It was not painful, and no hair was over it. seen to grow over it. The next morning he was put under chloroform, and the tumour was pared off after its peduncle had been ligatured in two halves. No bleeding from any vessel was observed, but slight, oozing ensued, which was stopped by tlie application of styptic colloid and dry lint. It. was dressed with Gramgee's tissue and carbolized Extreme debility followed the removal of tow. the tumour, and lasted for one day. The tumour, on dissection, was found to consist of fibrous and vascular tissues. The ligature came off on the 3rd January, and the ulcerated surface is healing gradually. ,
Dr. Sanders also exhibited CONCUSSION
OF
a case
of
THE BIIAIN,
by compression, in which recovery eventually took place. The following notes
followed
contain the main incidents of the case. Laljee Misser, a Hindu male, aged 20 years, admitted into the Hospital 011 the 24th ?was August 1885, at 2 p. M., for concussion of brain, left, side of head, a lacerated wound over the a contusion over its posterior part, a small lacerated wound over the right side of forehead, and superficial abrasions here and there over the body. These injuries were caused by a fall from On admission the deck of a ship into its hold. he was found pretty sensible, but dull; answering questions stammeringly ; could walk, but his gait was unsteady ; his pupils were normal, and responded to the action of light ; had no bleeding from the nose, mouth or ears; he had no perfect, control over his limbs, and his upper right eyelid was much swollen and ecchymosed ; pulse was small, feeble, and regular. In the evening he was insensible, and did not answer when called.; his upper extremities were crossed over the chest, and his pulse was small, slow, but regular. The following morning he became a little restless and more insensible; his pupils were slightly dilated, but responded to the action of light; pulse became a little full, and lie passed water in his bed clothes. Insensibility was the same, and the pulse became very small and slow, but regular till the morning of the 27th, when he was a little sensible, and paralysis of the left extremities was observed ; the lett pupil was normal, and the right one slightly dilated; passed one stool after enema. He had a little evening rise of temperature since evening of his admission till the 28th August, but the temperature was never higher than 101? F.
57
On 31st August a big blister was observed the inner side of the ball of the great toe, and on removing it the superficial tissues were found sloughy. Swelling and ecchymosis of the right upper eyelid gradually passed off, and ptosis of thislid was first observed on the 5th September, but the pupil became normal. Paralysis of the left limbs continued the same till the 2nd November, when it was first observed that he could move his paralyzed limbs a little. Improvement in the paralyzed limbs progressed gradually, and he could walk with help on the 21st. November, and a few days afterwards he was able to walk with the help of a stick. Ptosis has also gradually passed off. Now he walks about without the help of a stick, but has to drag his left leg a little. over
Dr. McLicod showed two SARCOMA
OF
specimens
of
THE
FOREARM, remarkable on account of the similarity of the tumours, their simultaneous treatment, and the satisfactory result of aseptic amputation. The following notes have been furnished by Assistant Surgeon Khagendra Nath Sen : I. G. C, Banerjea,adult,Hindu, male,get. 21, admitted, with sarcoma of the left forearm, on the 27th November 1885 ; duration one year. The tumour is spheroidal in shape, about the size of a child's head. It extends from the middle of the forearm to the middle of the palm of the hand, anteriorly as well as posteriorly. There are some prominent veins on its surface, lie can move his fingers slightly. The left axillary glands slightly enlarged ; no history of syphilis or gonorrhoea; all systems normal. Operation, 2nd December 1885.?Chloroform administered, and the left forearm amputated about its middle by the modified circular The flaps were brought together by method. two metallic and some horse-hair stitches; a drainage tube inserted. Dressed with iodoform and boraeic and bichloride gauze. Subsequent progress.?On the 8th December, the drainage tube and the wire stitches removed altogether, and the flaps seem to have All the horse-hair stitches reunited well. moved on the 13th December 1885. On the 26th, all the wounds seemed to have healed up except a small sore in the centre. Dressings changed eight times altogether. Left the Hoscured, on the 31st December 1885. which
were
-
?
pital^
Golam Safdar, adult,
Mahomedan, male, occupation a writer, admitted with sarcoma of right forearm ; duration five years; spheroidal, about the size of a melon, and exII.
a3t.
27, by
from the middle of the forearm to the wrist joint, anteriorly and postriorly, from the middle of the forearm to the upper ends of the
tending
THE INDIAN" MEDICAL- GAZETTE.
58
[Feb.,
1886.
111. Mr. E. S., railway engineer,European, metacarpal bones, skin over the tumour moveable, and some prominent veins on its surface. male, admitted with the right malleolus comBesides, some fluctuating points visible oil its pletely knocked off, and with lacerated Avounds surface.
over
both external and internal malleoli.
This
Operation, 16th December 1885.?Chloroform accident was caused by the foot being caught administered, forearm amputated about its between the spokes of a wheel and the platform middle by the modified circular method; eight of a trolly in motion. Admitted, on the 12th bleeding vessels tied. The flaps were united November, six hours after the accident. by th ree wire stitches and some horse-hair Dressed with iodoform and bichloride gauze, stitches; a drainage tube inserted; dressed and the leg put on a Mclntyre splint. with iodoform and bichloride gauze. Subsequent progress.?On the 14th the temSubsequent progress.?The patient left the perature rose to 101? F., in the evening, his Hospital 24 days after admission ; dressings bowels being confined. This was the only changed seven times altogether. On the 22nd occasion on which a rise was observed. At .December, the drainage tube, and on the 26th, first the dressings were changed every third the wire stitches, removed. On the 4th January day; the deep dressings being left untouched. 1886, the flaps were found to have united, a At the fifth dressing, a small slough was noticed small
sinus
remaining at one corner. 4th January 1886.
Dis-
charged, cured,
Dr. McLeod also related three cases of COMPOUND FRACTURE, which had recently been treated with marked success by means of antiseptics. I. Shomsere Beg, adult, Mahomedan, male, ajt. 29, admitted with subcoracoid dislocation of the right humerus and fracture (compound) the surgical neck of the humerus, caused through O by a fall from a horse whilst riding on the 1st December 1885. There is a small valvular opening on the inner side of the arm at its upper part, communicating with the cavity of the fracture. ls? December i885. Dislocation reduced by manipulation and extension, and the fracture put up in splints ; wound dressed antiseptically. On the 8th December, the splints were removed, and the valvular opening was found to have The fracture was agaiu put up in closed. and guttapercha splints. Discharged, angular cured, 26th December 1885. II. Bhartu, adult, Hindu, male, ajt. 30, admitted on the 11th December 1885 with compound fracture of the thigh about its middle. States that he was raising an iron beam on to the roof of a two-storied house, when accidentally the scaffold on which he was standing gave way, and he fell down with the beam, which struck him on his right thigh. There is one lacerated wound on the anterior aspect of the thigh, 2 inches long and 1 inch broad, and another punctured wound on the posterior aspect bleeding freely, both leading to the cavity of the fracture. Is quite conscious; pulse moderately full. ;
O
?
Subsequent progress.?Dressed antiseptically
dressings changed
Baboo Jogendra Nath Ghose showed several specimens found in the dissecting rooms of the Sealdah School: An undeveloped kidney in an adult 1. male, the opposite one being larger than usual. A portion of the head of the femur, 2. which was found loose in the acetabulum having been broken off during life. The cartilage showed signs of erosion. A neuroma of the median nerve3. Baboo Devendra Nath Dey showed 1. A LARGE RENAL CALCULUS, weighing drs., which was found in the college dissecting rooms. The kidney was disorganized. A specimen of Hodgkin's disease of 2. the SPLEEN. The Office Bearers for 1886 were then elected by ballot with the following result:? President.
Dr. D. O'C.
;
and after the seventh dressing, which took place on the 1 st January 1886, the posterior wound was found to have closed up entirely, and the anterior wound to be cicatrizing rapidly. From the 1st to the 13th instant, dressings changed only twice. (The wounds have since healed and the fracture is undergoing satisfactory repair.)
the outer wound.
From the 1st December every fourth day till his discharge on the 5th January 1886. The slough gradually separated, and the patient left the hospital with a small linear sore on the inner malleolus, and two small sores on the outer malleolus. He has written to say that the wounds have healed, and that lie has good motion at the ankle-joint. over
1
Raye.
Vice-Presidents. Dr. R. C. Sanders. Baboo Lall Madhub Mookerjee, L.M.S. Secretaries. Dr. K. McLeod. Moulvi Zuheroodeen Ahmed, L.M.S. Treasurer. Baboo Mahendra Nath Gupta, L.M.S. Executive Committee. Dr. J. M. Coates. Baboo Doyal Chunder Shome, M.B. Dr. B. Harvey. Baboo Rakhal Das Ghose, L.M.S. Dr. E. Chambers. Baboo Devendra Nath Dey, L.M.S.
