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Stadelmann Division of the "Am Urban" Hospital, who expressed himself very favorably after detailed experiments with these salts in cases of tuberculosis. In this report, however, I desire to mention only those cases in which my observations extended to the action of the drug in cases of tuberculous fever.

Each of the three salts, the salicylate of pyramidon as well as the acid and neutral camphorates, possesses decided antipyretic action, but not, however, in equal degree. The strongest antipyretic action is furnished by the salicylate, somewhat weaker by the neutral camphorate, and the least by the acid camphorate. The size of a single dose, with which we may secure a sufficient antipyretic action, varies according to the individual; in general, however, it may be said that to obtain equal results, the average dose of the salicylate is 0.25 to 0.30 gram (4 to 5 grains), to reduce the temperature 1-2° C., of the neutral camphorate 0.50 to 0.75 gram (71⁄2 to 12 grains) and of the acid camphorate, 0.50 to 1.0 gram (71⁄2 to 15 grains). The reduction of the temperature begins within the first quarter of an hour after taking the remedy, progresses equally, and after two hours approximately reaches the lowest degree. From there, the temperature begins to rise gradually and reaches, after five to six hours, its original height.

My experience shows that in cases of high fever it is best to administer larger doses at once. Thus, for instance, in the case of a man 37 years old, suffering from tuberculosis, with a temperature of 38.4° C. (102° F.), complete apyrexia followed in 11⁄2 hours after the administration of 0.25 gram (4 grains) of the salicylate of pyramidon. In the same patient, with the extension of the pulmonary process, the temperature suddenly rose to 39.2 to 39.8° C. (103 to 104° F.) after we had noted for weeks, daily afternoon temperature of 38.2 to 38.5° C. to 102°F.). In this state, 0.25 gram (4 grains) of the salicylate I could accomplish a reduction in temperature of only 0.4 to 0.5° C., whereas one dose of 0.50 gram (71⁄2 grains) produced in two hours a fall in the temperature to complete apyrexia. These experiences included also the action of the camphorate of pyrami

don.

(101°

One may secure very favorable results also with frequent, equally divided small doses administered daily, when it is desired to keep the patient free of fever. In cases of slight elevation in temperature, it suffices, for instance, to administer to the patient 0.25 gram (4 grains) of the salicylate three times daily at regular intervals in order to have the temperature remain at normal. The same is true of the neutral and acid camphora tes of pyramidon, only that somewhat larger doses of these salts must

be administered.

It must be stated, however, that one cannot depend with apodictical assurance to keep febrile patients completely free of fever by the administration of the pyramidon salts at long intervals. In many cases where the temperature did not exceed 38 to 38.5° C. 101 to 102° F.), the administration of 0.25 gram (4 grains) of the salicylate, morning, noon and night, sufficed to keep the patient free from fever. In one other case the patient was free from fever all day, whereas elevation of temperature would appear at night; nevertheless, complete apyrexia was secured in this case after the administration of a fourth dose of the salicylate. In another case, where the temperature exceeded 39° C. (102°F.), and where 0.50 gram (71⁄2 grains) of the salicylate of pyramidon three times daily was prescribed, complete apyrexia was not secured. In such cases, the desired result was obtained only after we administered 0.30 to 0.40 gram (41⁄2 to 6 grains) of the salicylate every two to three hours. To be sure, the, maximal dose was exceeded considerably, always a doubtful procedure in such severe cases.

Nevertheless, I can positively declare that even in these cases, in which a complete apyrexia could not be acquired because of the excessively high temperature, the fever could be lessened so much by the administration of one of the other of the pyramidon salts three to four times daily, that the patients always derived considerable benefit.

In cases in which the fever was accustomed to appear at a certain time, we always secured favorable results by the administration of the pyramidon salts one half hour before the expected appearance of the fever, when the regularly recurring fever would then either not occur, or would only be apparent by an elevation of one tenth of a degree of temperature.

It is not to be denied that the organism in certain ways accustoms itself to the pyramidon salts, and shows also individual fluctuations; generally, however, this process of the organism becoming accustomed to the pyramidon salts, develops very slowly. Should we observe, for instance, that the reduction of the temperature does not follow a certain dose as promptly as when before given, it suffices to increase the dose about 0.05 to 0.10 gram (34 to 2 grains), to again secure for a long time the former good results. In one of my cases, one daily dose of 0.25 gram (4 grains) of the salicylate for over four weeks produced a reduction of temperature of about 2° C.; from this time, however, there appeared an ever weakening action, so that toward the end of the fifth week, the same dose only produced a temperature fall of 0.6 to 0.7° C. An increase of the dose to 0.30 gram (41⁄2 grains again effected a deduction of 1.5° C. in the body tem

perature, and one dose of 0.40 gram (6 grains) even caused a fall of 2° C. in the temperature.

Untoward symptoms play a fairly secondary rôle in the clinical application of the pyramidon salts. In general, small doses are well borne by the patients, and rarely produce any disagreeable symptoms in the stomach, even though the drug be used continuously for a long time. Only in those cases where larger doses of the pyramidon salts have been administered for a very long time, have I noticed an impairment of the appetite. The gastric symptoms, however, were by no means of such importance as to preclude the further administration of the remedy.

A far more important effect, appearing after the use of the pyramidon salts and relative to which a great difference exists between the different salts, is the excretion of perspiration in the patient. The reduction of the temperature which follows the taking of the salicylate of pyramidon is sometimes accompanied by an excretion of perspiration, which is so intense that a further application, notwithstanding its otherwise favorable characteristics, must be discontinued. In several of my cases, the patient felt so exhausted as a result of the sweating, that it was only with great difficulty that I could persuade them to continue taking the salicylate of pyramidon.

As regards the camphorates of pyramidon, they differ in this respect not alone essentially and favorably from the salicylate, but also from all other antipyretics which are employed in tuberculosis. Indeed, they offer decided advantages over these reme dies, in that their administration is accompanied by scarcely apparent or only very insignificant excretion of sweat. Between the two camphorates of pyramidon there exists graduated dif ferences, in so far that the acid camphorate exercises, in addition to the antipyretic, a decidedly stronger antihydrotic action than the neutral camphorate. A new indication as regards the

application of the pyramidon salts is thereby apparent.

My

observations in this regard demonstrate that the acid camphorate should be regarded as a very reliable antipyretic and antihydrotic

exces

in those cases where the patients show an inclination to sive sweating. It is to be stated too, that the pyramidon salts beneficially influence the condition known as "air hunger," a characteristic absent in other antipyretics.

In none of my cases, could I discover an injurious effect of the pyramidon salts on the circulation, especially on the heart, even not in those febrile patients whose condition was quite and whose heart function was weak.

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In addition, the pyramidon salts possess very beneficial characteristics which, in appropriate cases, we designate as side effects

-that is, its decided "pain stilling" action. I had an opportunity to observe this beneficial effect on a patient with pulmonary tuberculosis by whom acute rheumatic polyarthritis developed, as well as on a patient ill with lumbago. The pain stilling quality of the salicylate proved quite satisfactory in both cases.

As a special indication for the application of the salicylate of pyramidon, I desire to cite those cases where pulmonary tuberculosis is complicated with pleuritis or with pleuritic exudation. In these cases I had the opportunity to observe not only the antipyretic but also the diuretic action of the salicylate. One of these cases was a woman with a beginning pulmonary tuberculosis, in whom there developed a pleuritic exudate which extended up to the third rib on the right side. The patient was given 0.50 gram (71⁄2 grains) of the salicylate of pyramidon three times. daily. The daily amount of the urine excreted gradually increased from 600 to 800 c.cm. to 2 to 21⁄2 litres, through which, by continued treatment, the exudate disappeared in a little more than two weeks. Besides the diuresis, the excessive sweating effected the diminution of the exudation. A second case con

cerned that of a young man, 24 years old, with pulmonary tuberculosis in an advanced stage, in whom the administration of 0.5 gram (71⁄2 grains) of the salicylate of pyramidon three times daily, completely resolved the exudate in 8 to 10 days. I regard it advisable to try large doses of the salicylate of pyramidon in all varieties of pleuritic exudation. This remedy should also be administered especially in those cases in which a febrile process of the lungs is associated with painful complications.

I sum up my observations as follows:

1. The pyramidon salts are valuable antipyretics, and as regards this antipyretic action, the salicylate surpasses both the camphorates of pyramidon.

2. The salicylate displays its antipyretic action in one dose of 0.25 to 0.50 gram (4 to 71⁄2 grains), and the camphorates in 0.50 to 1.0 gram (71⁄2 to 15 grains) pro dosi administered three times daily.

3. The salicylate of pyramidon may be employed in cases of pleuritic exudation.

4. All three pyramidon salts possess equal "pain stilling" qualities, and produce scarcely any untoward symptoms.

5. The acid camphorate exercises its temperature reducing effect without being followed by excessive sweating, and because of its antihydrotic action should be considered one of the most important of the prominent antipyretic remedies. Consequently it may be employed with advantage in cases of pulmonary tuberculosis accompanied by excessive secretion of sweat.

BUFFALO MEDICAL JOURNAL.

A Monthly Review of Medicine and Surgery.

EDITOR:

WILLIAM WARREN POTTER, M. D.

All communications, whether of a literary or business nature, books for review and exchanges, should be addressed to the editor 284 FRANKLIN ST., BUFFALO, N. Y.

VOL. XLIV.-Lx.

JULY, 1905.

No. 12

יT

American Gynecological Society.

HIS famous society held its thirtieth annual meeting at Niagara Falls, May 25-27, 1905, during which it disposed of an unusually instructive and interesting program. The social features of the occasion, besides the usual trolley excursions around the cataract environment to Queenston and the Gorge tour, included a reception on Thursday evening, May 25, by Dr. and Mrs. E. C. Dudley, and a smoker on Friday evening, given by Drs. Mann, Frederick, Ford, Van de Warker, and Robb,-all of which were numerously attended and greatly enjoyed.

The reception by the president and his charming wife, after the preliminaries were met, partook of the nature of a musicale, with Mrs. Evelyn Choate at the piano, Mr. Charles McCreary, baritone, and Dr. J. O. Frankenstein, tenor. Classic solos and duets, vocal and instrumental, were rendered and the artists received the generous encores of their charmed listeners.

THE PRESIDENT'S ADDRESS.

place

One of the special features of the scientific part of the meeting was the annual address of the president, Dr. E. C. Dudley, of Chicago. For many years Dr. Dudley has occupied a in the front rank of the profession as a gynecologist, teacher, and author, his textbook on gynecelogy being recognised as the best practical or working treatise yet published in America. Therefore, it was fitting that he should speak for the gynecological profession in clear tones and plain language in refutation of some of the aspersions that have been cast against it both by gynecologists and others. Particularly did he emphasise the fact

that

the "passing of gynecology" has not taken place, and he warned all prospectors, with dog, pick, and gun to "keep off" the claim.

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