RESORCIN AS AN- ANTI P VRETIC, B Y- W- CARROLL CHAPMAN, M. D- -OF- LOUISVILLE, KY. RESORCIN AS AN ANTIPYRETIC Bead before the Kentucky Stale Medical Society, Mn.11 1891. By VVr. Carroll Chapman, M. D. Mr. President and Gentlemen: It is my wish to call the attention of the medical profession more closely to a drug which has been especially under my observation since 1884. During a period of seven years I have prescribed resorcin almost daily,>as an antipyretic, in the different fevers peculiar to this cli- mate, with most satisfactory results; and particularly in the pyrexia attending sep- ticaemia, malaria, typhoid fever, measles, dysentary and cholera infantum have its effects been highly gratifying. Its value has been underestimated by those author- ities who have given it any thing like a thorough trial, to such an extent that few of the Materia Medica’s give it any men- tion at all, Remington’s Pharmacopoeia merely names it as an antiseptic. The U. S. dispensatory, until the fifteenth and sixteenth editions, barely gave it a passing notice. The sixteenth edition grants it more space and reviews it at some length, from which I shall qoute later on. Barthalow’s Materia Medica, 2 Resorcin as an Antipyretic. fourth edition, contains the earliest ac- count of resorcin, I have seen, which ap- proaches accuracy in describing its phy- siological and therapeutical action. Even he classes it with the antiseptics, though he makes more mention of it in connec- tion with its antipyretic action, and states that “ in intermittent fever remarkable results have been lately obtained, which, if confirmed, will put resorcin in the front rank of remedies for malarial dis- eases. Indeed, it is highly prob ible that in one of the members of this group we will presently have a real rival and an equal to quinine.” Having then been classed as an anti- septic; having received merely passing notice heretofore; having been looked upon by some experimenters with dis- trust as dangerous; what wonder that the antipyretic value of resorcin is little known and that precedence is given other remedies lacking in some of the special properties, possessed by resorcin, which make it of the highest worth, in the diseases mentioned above ? Under these circumstances I feel that this arti- cle would he greatly shorne of its value were the history and properties of resor- cin omitted; and, in relating them, will cite Andeer as my principal authority. History.—Resorcin is a chemical com- pound, discovered by Hlasiwetz and Barth, and was obtained from certain Resorcin as an Antipyretic. 3 resins by the action of fusing alkalies. They assigned to the new compound the name resorcin, partly because it is derived from a resin, and partly because it has some similarityto orcin a.peculiar sub- stance obtained from archil. Subsequent- ly resorcin was constructed synthetically by Korner, and at the present time it is obtained in various ways the product be- ing both pure and cheap. Properties.—Resorcin is a member of the phenol group. It occurs in tabular prysmatic chrystals, colorless or slightly pinkish, rather shining and lustrous, somewhat sweetish taste, with a little after-pungency. When struck or rubbed in the dark, it appears phosphorescent. Odor very slightly pronounced. It is freely soluble in water in the proportion of 86.4 parts of resorcin to 100 parts of water at o- c. It is dissolved by all liq- uids except chloroform and carbon sul- phide. The best vechieles are water, syrup of lemon, or glyrerine. It is anti- pyretic, antiseptic and antifermentative. Dose.—For adults two grains to two scruples. AntagonistsFrom the physiological stand-point, resorcin is antagonized by the cerebral excitants, by the agents which raise the arterial tension, and by the cardiae and respiratory stimulents— Atropia esyecially. 4 Resorcin as an Antipyretic. Synergists—Quinia, aconite, salyci- liac acid, carbolic acid. etc. Physiological Actions.—Resorcin does not irritate, nor is it absorbed by the un- broken integument. The solution injec- ted into the subcutaneous tissues produces but little irritation, and never inflamma- tion and abscess. It has decided anti- ferment properties, arrests decomposi ion in animal tissues, deodorizes, and is de- structive of the minute organisms on the presence ot which putrefactive decompo- sition is dependent; and thus changes the character and odor of the contents of the alimentary canal in certain diseases; be- sides having as claimed by Lichtheim and others, a specific action upon the mucous membrane. When a considerable dose of resorcin, thirty to fourty grains, is administered to a person in a fever, in a few minutes a sense of heat is felt about the epigas- trium, and spreads thence over the sys- tem; the face flushes and grows hot, the eves glisten, the breathing and pulse are accelerated, and dizziness, with ringing in the ears, and frontal headache are ex- perienced. A good deal of discomfort, oppression of the chest, and a sense of distension of the head, are usually pro- duced; hut these sensations subside in from ten to fifteen minutes,the skin then grows moists, and in a few minutes more a profuse perspiration is pouring out on Resorcin- as an Antipyretic. 5 the surface of the body. The pulse then falls, coolness succeeds to heat, langour to tension, and the temperature of the body declines several degrees. If the feverish state has no special features, the lessening of the pulse and the reduction of the temperature to the normal occurs in about one hour. Shoemaker savs thirty to sixty grains reduce the tempera- ture in two or three hours ; but he cer- tainly must have used it in some other fever than the ones named above for the effect to have been so delayed. He fur- ther says resorcin has the disadvantage of causing nausea. I have never seen any other author make this claim. On the other hand all the authors I have consulted, except him, recommend it strongly in treatment of the various gas- trointestinal affections, partly for its anti- fermentative action, and partly for a specific influence upon the mucous mem- brane. In my experience nausea has only in the rarest instances been caused by resorcin. The pulse may be slowed one- third and the reduction of temperature be as much as four degrees Far. by a dose of thiity grains. This reduction would last from two to four hours. When the rise of temperature begins again, a sense of chilliness is experienced, which may even take the form of a distinc- rigor. Lichtheim observed great differ- ence in the power of resorcin in different 6 Resorcin as an Antipyretic. fevers. The less the tendency to spon- taneous remissions, the less the antipyre- tic effect. All fevers yield to some ex- tent to its rntipyretic action, but pneu- monia, bronchitis and erysipelas are least amenable. The preliminery of excitement, which lasts from ten to twen- ty minutes may be accompanied by de- lerium. 7'oxic Action.—No case of fatal pois- oning, so far as known, has been recorded. Sixty grams have caused collapse and unconsciousness. Andeer took one hun- dred and fifty grains and shortly after became unconscious, this was followed by epileptiform convulsions, opisthotonos, and increased respiration .Consciousness returned in five hours. Very large doses cause immediate diastolic arrest of whole heart. (U. S. dispensatory 16th ed.) Therapy.—Although some corres- pondence exists in the therapeutical ap- plications of the members of the phenol group, especially between their anti fer- mentative and antipyretic action, resorcin is much the more desirable fora number of reasons, ist. It is fully as, if not the most, reliable. 2nd. The ease with which it can be administered; being free- ly soluble, of pleasant taste, and free from disagreeable odor. 3rd, It not only does not cause nansea and vomiting, but tends to correct disorders arising from fermentation, or a catarrhal condition of Resorcin as an Antipyretic, 7 the gastrointestinal tract. 4th. The physiological action is so plain and can he watched with such ease. 5th. In a dose sufficient to reduce the temperature three or four degress (thirty to forty grains) there is not the least danger. As a remedy in septicaemia I regard it as being without an equal, in the list of therapentic agents, for controling the febrile stage and the septic condition. I know of no way I could explain the cause of my belief in this than to cite you to my experience in an epidemic of sep- ticaemia. During the spring of 1884, while resident physician of the Maternity Hospital in Baltimore, puerperal septic- aemia developed. The two first cases were attended according to the usual line of treatment in that disease : intrauterine douche, iodoform suppositories, quinia, salycilate of soda, digitalis, with ice cap and bags, followed by stimulants. Both cases died on the sixth or eighth day of the disease. Case 3, Annie A , aged 28 years; second child. On the fourth day after delivery was seized with a chill followed by high fever, and ordered to be moved into the septicaemic ward. Temperature 104-, pulse 110: characteristic offensive discharge. Immediately began routine of treatment as related above, without being able to control the fever, and the stomach becoming so disordered that the Resorcin as an Antipyretic. patient could retain nothing’ more than Small quantities of stimulants. In my search for other remedies, and eagerness to grasp anything promising the faintest hope, I found and tried resorcin. On the sixth day of the disease, tenth day after delivery with her temperature 1064-, pulse 135, 1 administered thirty grains of resorcin and sat by to watch the re- sult. She retained it. In about ten minuets the eyes began to glisten, the face flushed, the respiration quickened, the pulse 140, with increased restlessness. This lasted for a few minutes when the forehead became moist closely followed by profuse perspiration over the surface of the hotly: the breathing became slow- er and eaiser and in one hours time I found her temperature 103.5' an(l pulse no. Gave twenty grains more and or- dered five grains every hour for four hours at which time I found the tempera- ture 101", pulse92. Patient ate an egg and found no difficulty in retaining it, or medicine or stimulants. With five grains every hour or, two after this, was able to keep the temperature ranging from 100• to 102 •, except at one time, when the resorcin was omitted for several doses, when the temperature went to 103- Al- though she was able to retain stimulants and liquid food from this on the patient died in the third week of the disease. Encouraged by the effects of the resor- Resorcin as an Antipyretic. 9 (*in in this case I began it’s use in each subsequent case, accompanied, at times, by the ice cap and of course the intra- uterine douche and stimulants, being able to control the fever to a great extent. Never found it necessary to give over thirty grains in a single dose. The stomach rarely ever refused to retain li- quid food and stimulants. Out of eight cases of septicaemia four recovered and four died. Of those that died, two did so before the resorcin was used. In the third, resorcin was not be- gun until the sixth day of the disease, then, after other remedies had failed, the temperature responded to its use. Of the five cases treated with resorcin, from the beginning, four recovered. It is true the latter cases seemed milder, all the way through; but might not this been due to the resorcin itself, by the readiness with which the fever responded to the remedy, the slight derangement of the stomach, allowing a freer use of sustaining reme- dies, and finally to it’s antiseptic proper- ties? Of this latter quality 1 wish to ask your consideration especially. It can be done most briefly by reciting one more case. Mrs. L , January 18th, 1891; abor- tion, fourth month of pregnancy. Great deal of hemorrage, after foetus passed, which continued for two hours; so de- cided to take the placeuta away. Did so 10 Resorcin as an Antipyretic. in small pieces as long as I could discov- er the least particle. Ordered vaginal injections one two thousandth per cent. Bichloride of mercury. Previous history of malaria. Fourth day after delivery the lochia assumed offensive odor; diarr- hoea, faeces pale, ashen color. Prescrib- ed quiuia sulph-three grains, resorcin five grains every two hours. Sixth day chil- ly sensations, temperature 102.5*-, pulse j 10. Peculiar appearance of the eyes and face, with red cheeks more distinct- ly marked of evening, as was the tem- perature which reached 103-, as the highest. Patient took a quart or three pints of milk daily and stimulants. With this treatment the temperature except on two days ranged from ioo-* to 102 •. Fever subsided on fifteenth day, but re- covery slow, To those who doubt this having been septic poisoning 1 could, ex- cept for space, relate one more case un- der my care, precisely similar, except the malarial history, with same treatment, and recovery dating from the twentieth day. While these few cases are not suffici- ent to form positive knowledge of the influence of resorcin in septicaemia, they seem worthy of the careful consideration, of reliable observers and, if time and trial confim them, septicaemia will not be so much dreaded in the future. In malaria, remittent form, it reduces Resorcin as an Antipyretic, the high fever more quickly than quinia hut is best combined with the hist named drug, in order to eradicate the poison from the system; though, I have cured remittent fever with the use of resorcin alone. In rhe intermittent type it is best to give resorcin during the exacerbation and qviinia during the intermission. In typhoid fever it certainly seems to be indicated. While it does not, of course, control the fever it is fully as effici- ent, in this line, as any other antipyretic; and given in five grain doses, every two hours, will, I beleive, prevent excessive list of temperature. It has the decided advantage of not deranging the stomach, and it is in the rarest instances that liquid food will not be admitted. By its anti- fermentative action it prevents excessive tympanitis. If. the belief of Hoefer, Lichtheim and others in confirmed,as to the specific action of resorcin on the mucous membrane, it will surely be indi- cated as a guard against excessive sloug- ing of the Peyerian and solitary glands and the consequent intestinal ulceration. In measles in the begininning of the second stage, when the eruption is slow about coming to the surface and the skin is dry, with irritating cough, it fills the office of sudorific and antipyretic, hasten- ing the eruption, soothing the irritation and reducing the temperature. In dysentery and cholera infantum I 12 Resorcin as an Antipyretic. have given it less often than in the diseases memtioned above, but have found the re- sults perfectly satisfactory. In giving resorcin a trial, those who administer it first, in pneumonia, bronchi- tis or erysipelas and aut:cipate its best effect, are likely to be disappointed, be- cause it not only is not especially indica- ted iii these diseases, but it seems here to have no superiority over a number of other antipyretics. To summarize then, resorcin is most valuable in fevers where there is a ten- dency to gastro intestinal derangement, whether due to septic or other cause ; in patients where a pleasant medicine is re- quired, for children especially ; in cases where the fever is very high, and a quick result is desired, and the physician wishes to watch the physiological action of the drug;and finally, in measles, when temperture is high and the euruption delayed.