Phenacetin

“ This examination appears to demonstrate that the chemical substance, para-acetphenetidin, whether sold as acetphenetidin, U. S. P., or as phenacetin, is practically identical. The impurity of the product of some of the specimens coming from Powers-Weightman-Rosengarten Co. is too slight to be considered dangerous. Furthermore, a comparison of the “lot numbers” indicates that this firm has been improving its product steadily so that in the future its assurances of an unimpeachable product may be relied on. ”

“ Failing to comply with the law, they must go out of business. The latter alternative was not to be thought of. The profits gained by selling, with the aid of careless or ignorant physicians, a five- or ten-cent mixture for $1 were too great to be surrendered without a struggle. The same brilliant intellect, perhaps, that first saw the commercial possibilities in the business said: “Change the formula. Phenacetin is about as cheap as acetanilid; the patent has just expired and consequently we can get it at a low price. Let us substitute phenacetin for acetanilid.” ”

“ At the same time hot drinks should be given, such as weak tea, in order to promote [209] perspiration and cut short the hot stage, and at this stage, i.e., at the outset of the fever, 10 grains of Antipyrin, or 10 grains of Phenacetin, may be found useful for inducing perspiration, or four tablets of Warburg’s Tincture, which contains some quinine, may be substituted for them. Antipyrin and Phenacetin should not be given except in the earliest stages of the fever. ”

“ The physiological action of phenacetin consists in a sedative action on the sensory tracts of the spinal cord, and a depressant action on the heart, where it tends to paralyse the action of the cardiac muscle. Upon the bodily heat it exercises a marked effect, decreasing the action of the heat-producing centre as well as increasing the dissipation of heat, and thus causing a marked fall in temperature. ”

“ What is the difference if one is more dangerous than the other? The fact that the Antikamnia sold abroad differs from that sold in this country some may say is of no special interest to us. Still this fact is worth noting: The dose of acetphenetidin—​phenacetin—​ (71⁄2 grains) is nearly double that of acetanilid (4 grains) : one becoming accustomed to a certain dosage of the nostrum as sold in this country might, while abroad, unwittingly be led to take a double dose of acetanilid.​— (Abstracted from The Journal A. M. A., Feb. 8, 1908.) ”

“ Cold bath is not suitable in plague patients on account of the movement of the body which it entails, and also on account of the serious cardiac depression which accompanies the disease. Two grains of phenacetin with 1 grain of hydrobromate of quinine is a safe antipyretic. ”

“ This was accomplished in fact by changing the formula and substituting acetphenetidin (phenacetin) for the acetanilid. While acetphenetidin is somewhat less toxic than acetanilid, bulk for bulk, the toxicity and therapeutic activity of the two drugs are nearly proportional.
The claim made by many proprietary medicine manufacturers that they are “strictly ethical” because they advertise only to physicians is mere verbal camouflage. There may be no more certain way of insuring the continued use of a nostrum by the public than to have it prescribed by physicians ”

“ Headache.—Take 10 grains of salicylate of sodium every hour, for 2 or 3 hours, or 7 grains of phenacetin every half-hour for an hour and a half. A drachm of potassium bromide at night will often relieve headache and sleeplessness. More "natural" cures are to lie down in a dark room and fast, or to sip a glass of cold water slowly. An aperient is often all that is needed. ”

“ Most of the remedies taken for headache contain some harmful drug. If you look carefully at the label, you usually will find that they contain morphine, phenacetin, or acetanilid, which are very depressing to the heart. Pain is the cry of tortured nerves, so if one suffers from headaches or backaches, she should not take any of these harmful drugs, but should hunt for the cause of the pain and remove that. ”

“ Boone in his arduous search for truth on the “much mooted question, ‘Is acetanilid a habit-forming drug?’” we direct his attention to a work that should prove of invaluable assistance. We refer to Bulletin 126 of the Bureau of Chemistry, entitled “The Harmful Effects of Acetanilid, Antipyrin and Phenacetin.” This interesting study to which we have previously called attention records 112 cases of the acetanilid habit. Of this number at least 50, or 44.6 per cent. of the cases were those of patients who took proprietary preparations of the drug. ”

“ Wherever there was a persistent headache, some one of the coal-tar products was used, and “headache powders” multiplied.
But a little further knowledge led physicians to question the expediency of using acetanilid, phenacetin, antipyrin, or any of the coal-tar preparations in other than exceptional cases. Heart-failure and other dangerous results so frequently followed their use that the wisdom of using them at all became doubtful. As our knowledge increases, we are likely to find both the wisdom and necessity entirely disappearing. ”

“ Salicin, salol, or phenacetin may be used as substitutes. Where the disease has been largely localized, blisters have appeared to be beneficial.
Phosphates and phosphorus have been lauded by German veterinarians, but in other hands, and when the morbid process was active they have proved useless, or even hurtful. Bone dust or phosphate of lime or soda may be freely used at any time and appears to act as a general tonic, beside supplying lime and phosphoric acid which may possibly be availed of for bone nutrition. ”

“ Liniments containing opium, belladonna or aconite rubbed into the affected part will often soothe the most severe local pain. And antipyrin, phenacetin, aspirin and similar analgetics are commonly taken. ”

“ Treatment.—The medicinal treatment consists at first in combating the toxin of the disease and assuaging pain, and later in promoting strength. Hot lemonade and whisky may be given during the chilly period and a single six- to ten-grain dose of quinine. Pain is combated by phenacetin, [8] three grains repeated every three hours till relieved. At night a most useful medicine to afford comfort when pain and sleeplessness are troublesome, is Dover's powder, ten grains (or codeine, one grain) , with thirty grains of sodium bromide dissolved in water. ”

“ Treatment.—Any article of diet which experience has shown to provoke an attack should naturally be [Pg 115] avoided. A Seidlitz powder, or tablespoonful of Epsom salts in a glassful of water, is advisable at the onset of an attack. Rubbing the forehead with a menthol pencil will afford some relief. Hot strong tea with lemon juice is sometimes of service. To actually lessen the pain one of the following may be tried: phenacetin (eight grains) and repeat once in an hour if necessary until three doses are taken by an adult; or, migraine tablets, two in number, and do not repeat ”

“ In man with a suspicion of traumatic origin, W. H. Thomson strongly advocates a persevering use of the hot water douche to the parts first affected, the hypodermic use of morphia and atropia, and in case of local anæmia nitro-glycerine every three hours. Where there is a suspicion of inflammation he successfully employs absolute rest, with opium narcotism so as to abolish the pain, for twenty days if necessary. Aconite, antipyrin, acetanilid, phenacetin, exaglin, and gelsemium have their advocates, and may benefit in individual cases. ”

“ Phenacetine may be given for the headache although ice water compresses are generally sufficient. In algid states hot water bottles should be applied to the body. During convalescence excesses in food or drink should be avoided as well as fatigue or exposure to wet or cold. ”

“ Phenacetine, gr. 5. 100 at 50 cents per C. One tablet every four hours to reduce fever as in colds, some forms of dysentery, and in severe headache. To be99 discarded when case bids fair to become prolonged. No. 9. Elaterin, gr. 1/16. 25 at one cent each. Use one tablet only where it is necessary to secure an immediate watery passage from the bowels in order to sweep out offending masses. No. 10. Dover's powder, gr. 5. 100 at 50 cents per C. Use one tablet every four hours in sudden acute colds. Its most valuable field is in the colds and bronchitis of children. ”

“ P.-M. exam. of, 63; retraction of, 128, 130 Penny, on arsenic, 275 Perforation, in poisoning, 237, 242, 259, 278, 300, 333 Peritonitis, 110, 242 Peroxide of hydrogen, 92, 93, 101 Petition, in lunacy, 207, 210-13 Petty jury, 5 Peyer‘s patches, 327, 330, 331 Pharmacy Act, 228 Phenacetin, 363 Phenazonum, 363 Phenol, phenic acid, 254 Phlyctænæ, in putrefaction, 113 Phosphomobylic acid, 335 Phosphoretted hydrogen, 403 Phosphorus, 231, 239, 243, 267 et seq.; Phosphotungstic acid, 335 Physiological test (strych.) ”

“ Each statement has been proved to be a definite and unequivocal falsehood. Phenalgin is not and never was a “synthetic.” Phenalgin is not and never was the only acetanilid mixture containing carbonate of ammonium. Phenalgin is not and never was in any sense of the word non-toxic. Phenalgin, in short, possesses the properties—​both good and bad—​that are common to acetanilid. It is a mixture that the merest tyro in pharmacy could dispense and for which any sophomore medical student could write a prescription without stopping to think. Acetanilid sells at 8 cents an ounce wholesale ”

“ In Merck’s Archives, page 11, we are told in an advertisement on ‘Phenalgin’ that it ‘is a compound of peculiar character which cannot be ex­tem­por­an­eous­ly made from powdered drug’ and ‘our process of manufacturing tablets is coincident with the manufacture of Phenalgin and is the result of a long series of careful experiments by which we are able to produce tablets of Phenalgin in a friable condition without losing any of its volatile constituents or undergoing chemical changes from heat or moisture’! ”

“ Then the Council on Pharmacy and Chemistry was brought into existence. One of the first pieces of work done by the Council was the publication of the results of a number of analyses of headache powders. Phenalgin was among them. Analysis showed that Phenalgin was not a synthetic but a simple mixture of the following ingredients in the proportions given:
The Etna Chemical Company, which puts out this product, was considerably disturbed by the Council’s exposure. ”

“ I Phenergan is Wyeth's brand name for promethazine hydrochloride, an antihistamine used to treat nausea. The injectable form of Phenergan can be administered intramuscularly or intravenously, and it can be administered intravenously through either the "IV-push" method, whereby the drug is injected directly into a patient's vein, or the "IV-drip" method, whereby the drug is introduced into a saline solution in a hanging intravenous bag and slowly descends through a catheter inserted in a patient's vein. The drug is corrosive and causes irreversible gangrene if it enters a patient's artery. ”

“ Phenol dissolves readily in concentrated sulphuric acid, a mixture of phenol-ortho- and -para-sulphonic acids being formed. These acids may be separated by conversion into their potassium salts, which are then fractionally crystallized, the potassium salt of the para-acid separating first. The ortho-acid, in the form of its aqueous solution, is sometimes used as an antiseptic, under the name of aseptol. A thiophenol, C6H5SH, is known, and is prepared by the action of phosphorus pentasulphide on phenol, or by distilling a mixture of sodium benzene sulphonate and potassium sulphydrate. ”

“ A phenol, e.g. crude cresylic acid, is heated with the equivalent amount of sulphuric acid for a few hours to 100°-210° C., cooled, and formaldehyde added slowly whilst cooling and stirring, in the proportion of one molecule of formaldehyde to 2 molecules of phenol. The free mineral acid is neutralized, and the resulting product is the syntan "Neradol." By this procedure only water-soluble products are obtained, but an alternative process is to heat the phenols in slightly acid solution, and then to render soluble the resinous products obtained by treating with sulphuric acid. ”

“ In the first place, we call attention to the fact that “Phenylacetamide” is substituted for “Acetanilidum” when it is to go into Phenalgin. To mystify is one of the “tricks of the trade.” Few physicians keep up with chemical terms and, therefore, are not supposed to know that Phenylacetamide is one of the chemical names for Acetanilid. ”

“ Phenazone is an isomer of phenazine, to which it bears the same relation that plienanthrene bears to anthracene. It is formed by reducing diortho-dinitrodiphenyl with sodium amalgam and methyl alcohol, or by heating diphenylene-ortho-dihydrazine with hydrochloric acid to 150° C. It crystallizes in needles which melt at 156° C. Potassium permanganate oxidizes it to pyridazine tetracarboxylic acid. ”

“ In Germany all serums which are obtained from animals, mostly horses, are mixed with 0.5 percent of phenol and carbolic acid—in order to preserve them—i. e., to 400 cubic centimeters I added a concentration of two cubic centimeters of phenol acid. This amount is, of course, far above the tolerance of human beings. Carbolic acid is one of the strongest acids we possess. When treating people with gas gangrene serums a number of deaths occurred. We discussed whether we were dealing with cases of serum death, resulting from the serum, or whether death was caused by the phenol added. ”