7IJWIPYWE 
BY 
BENJAMIN MARSHALL, M. D, 
SAN FRANCISCO, &AL. 
REPRINT FROM 
"Pacific Medical and Surgical Journal and Western Lancet" 
July, 1888. Antipyrine. 
By BENJAMIN MARSHALL, M. D., San Francisco. 
Occasionally there is made known to the medical world the 
discovery of some new medicine or new power in an old one, 
which is so startlingly promising for good in a new direction, 
as to enlist universal interest and investigation. The medical 
and laity journals teem with its wonderful properties from num- 
berless observers. The warnings of wiseacres come in and then 
the sum total of its power is approximated, and the remedy 
drops into its proper niche in all the text-books. Such has 
been the history of late years with, for instance, chloroform, co- 
caine, and later antipyrine. 
This substance had been in common use as an antipyretic for 
several years, but about one year since Germain See published 
his experience in its use, announcing a new property which was 
so promising for good, as to challenge criticism from the least 
skeptical. Subsequent experience has not only fulfilled that 
promise, but shown that the half had not been told. This drug 
has now about run the usual course. Six months ago no medi- 
cal journal was without from one to many notices of its uses, 
whereas, now, it is seldom mentioned, and already is it rele- 
gated to its presumably proper place as an antipyretic and 
analgesic. 2 
One object of this paper is to protest against a too summary 
verdict upon this medicine. For although the literature on the 
subject has been very profuse, too much so against it perhaps, 
it is by no means certain that it is exhausted in the other direc- 
tion, for continued experimentation is rapidly broadening its 
field for usefulness and in directions which must make us search 
for other modes of action than those already accorded to it. 
We call chloroform an anesthetic and apply it in the ranges 
covered by that effect. We call cocaine a local anesthetic and 
nerve stimulant, and it takes its place as such; but antipyrine, 
what shall we call it? Antipyretic? Yes. Analgesic? Yes. 
But what else ? This part of the field though partially is not 
yet lully explored and the question, how else may it act ? is 
still an unknown quantity to the thinking mind which, recog- 
nizes its broadening effects. I say then, let us not through fear 
of seeming to deal in a subject which is trite, or through pre- 
judice against a remedy which is proprietary and used to a large 
degree empirically, relegate it to the text-books on its present 
reputation, but keep the matter in discussion until its full power 
for good is known. 
It is not within the scope of this present paper to elaborate this 
portion of my subject, but rather to epitomize my own experience 
and that of others, as to its dangers, uses, and possibilities. 
I have said that too much has been written against it. I say 
this conscientiously, for I cannot help but feel convinced that 
all or nearly all the direful consequences laid against its use 
are easily explained away. By coincidence, as, for instance, 3 
when a patient suffering with peritonitis dies in collapse, after 
taking an insignificant close of the medicine. The most notice- 
able case on record being of that character, the editor very 
justly interpolating an interrogation mark (though in the wrong 
place). Or again, when the medicine has been improperly ad- 
ministered. As in combination with spirits nitre in which a 
deadly compound results, the aniline being set free. Of course, 
I do not forget that many persons have idiosyncrasies, which 
render them obnoxious to its use in the way of urticarial erup- 
tions and other discomforts, all of which is true of many other 
very simple things,-shell-fish, strawberries, etc., merely the 
reflex expression of some local irritation, and easily avoided with 
antipyrine by giving it in plenty of water. For this reason it 
should not be given by the mouth without adding at least gii. of 
water to every ten grains. I have never known of any incon- 
venience when given in this way. The greatest danger yet to 
come probably will be when it is thrown upon the market by 
irresponsible manufacturers. This danger is greater from the 
delicacy-of its composition and the absence so far of any true 
test of its purity. I have known twenty grains to be taken in- 
advertently for eight consecutive hours without any bad effect, 
and although it might not be advisable with our present knowl- 
edge to give it in large doses in advanced heart disease, yet I 
could not say why, since the records do not show that it has any 
effect on the normal temperature, or that in fever it lowers it 
more than one or two degrees below that mark, proving it to be 
as harmless as veratrum viride, against which the first fatal 4 
collapse, even in advanced heart disease, remains to be recorded. 
What the effect of antipyrine might be when continued for a 
long time, is as yet conjectural, but probably not more serious 
than that of the continued suffering which would make such a 
use of it desirable. 
It has been a question of much 'anxiety to learn what effect 
we might expect upon the kidneys. That it diminishes the quan- 
tity of urine is observed by all. In diabetes insipidus it acts 
sometimes marvelously well, but in glycosuria, although the 
amount of urine is greatly diminished, and in some cases the 
sugar also, the rapidly increased elimination of albumen has 
given halt to its continued use. Upon the normal kidney it has 
but little effect, except in most instances lessening the secretion 
slightly. The induced presence of albumen has not been noticed 
even after continued Upon all the other secretions its in- 
fluence is apparently nil. 
I would therefore claim that in antipyrine we have: First, an 
anti-pyretic which is effectual and safe, differing from most oth- 
er anti-pyretics in being more or less curative; as such it is 
most useful in traumatic and rheumatic fevers, and in the first 
stages of all fevers or acute diseases not of septic origin, its 
usefulness for permanent relief being in proportion to the stage 
of the disease. For instance in acute rheumatism, I believe it 
to be curative; in sub acute, less so, and in chronic palliative as 
a rule only. I do not believe that its usefulness ends at the 
absence of positive indications for its employment, as an anti- 
pyretic but that it may be valuable long after that or through- 5 
out the course of a disease to palliate the discomforts attending 
the febrile condition. It has been found especially serviceable 
in the acute diseases of children, who tolerate the medicine 
well, requiring larger proportional doses to obtain the same 
effect. 
Second. As an analgesic it stands pre-eminently above all oth- 
ers. Free from the accompanying or after effects of opiates, 
anesthetics and other like remedies, and more rapidly effectual. 
Whether given by the mouth, the rectum or hyperdermically, 
it subtly removes pain of the most agonizing nature. Not 
stimulating or exhilarating to the nervous system, there seems 
to be no danger of forming habits uncontrollable, as evidenced 
by the fact that although in common use for so long that con- 
tingency is not even considered. One hundred grains in twen- 
ty-four hours in divided doses, may be given by the mouth, 
seven to ten grains, at intervals of thirty minutes, six or seven 
times hyperdermically, and per rectum it is said that equal or 
smaller doses than given by the mouth produce the same effect. 
A sitting posture is preferable if the pain is in the upper ex- 
tremity, and a recumbent one if in the lower, as well as a dark- 
ened room, avoidance of conversation or other mental occupa- 
tion 
There remains something else to be said in this direction, and 
that as to its external uses. Little has been recorded as yet, 
but that there are possibilities foi' good is beyond question. It 
has been used much in the same way as Hamamelis and appar- 6 
ently with about the same effect, notably in hemorrhoids and 
as a local haemostatic. 
Third. What else is it ? I have already claimed that together 
with its anti-pyretic effect it has a curative power. I will say 
more. I claim that it will prove to be a specific for some dis- 
eases hitherto considered troublesome if not intractable- 
migraine for instance. And I have in mind several cases of 
gout, all typical, where the explosion was sudden and excru- 
ciatingly painful and when I remember that in twenty or thirty 
minutes the pain was rendered bearable-if not entirely relieved 
-and that these attacks under a proper continuance of the 
medicine were cured more certainly and more permanently than 
with colchicum, without the disagreeable consequences so fre- 
quently attending the use of that medicine, and also that the 
diathesis seemed to be so modified as to render the attacks less 
severe and less often, I cannot help hoping for a bright future 
for this remedy in this direction, if the future experience of 
others and myself should verify these experiments. In which 
event, if, as it is claimed, uric acid is not eliminated under its 
use, the etiology of gout is still a mystery. What this power 
is I do not pretend to say. I leave this part of my 
subject for future discussion, but the varied and contra- 
dictory uses to which this medicine has been applied is 
bewildering to those who are accustomed to look for a 
reason for everything. Sthenic, asthenic diseases, epilepsy, 
labor pains, hysteria, carbuncles, all yield more or less to its 
potent influence, while the field is still widening; and yet there 7 
is an acknowledgment to be made, which is, that occasionally 
a most simple and obvious indication for its application arises, 
in which we are disappointed and must resort to something 
else. But these exceptions are rare and not of sufficiently fre- 
quent occurrence to affect the general rule. In closing this 
article let me again earnestly urge the continued reporting of 
new successes or unique results in the use of this medicine, and 
also to pay my tribute to the genius of the man who first made 
known the value of this remedy. Numberless people now 
thank the one who has brought relief to their sufferings, and in 
future time the name of Germain See will stand with that 
of the discoverer of the anesthetic power of chloroform. 
The following cases taken from my notes will give some idea 
of the varied conditions in which this medicine has proved use- 
ful in my hands, and is mostly in accordance with the experi- 
ence of others as reported in the Medical Journals. 
1st-Gout. Mr. E. M., aet. 55, has been subject to attacks of 
gout for years, which were gradually becoming more frequent, 
and of late at intervals of four or five weeks; was depending 
upon a patent remedy composed, evidently, largely of colchicum, 
and from which he did not usually receive any relief under 
twenty-four hours. I was called at the beginning of one of his 
attacks and requested to give him an hypodermic injection of 
morphine to ease his suffering until his usual remedy should 
take effect. His right wrist and elbow were swollen and excru- 
ciatingly painful. Disregarding his request, I ordered antipy- 
rine; gave him twenty-five grains; turned down the light; 8 
told him to keep quiet; have no one in the room to talk to; and 
left myself. In thirty minutes I returned and awakened him 
from a sleep; the pain was immensely relieved. I then or- 
dered ten grains to be given every two hours, and left him for 
twelve hours. Upon my next visit he was around the house. 
Feeling delighted at being so quickly relieved, for the pain was 
quite all gone, I then put him on ten grains every four hours 
for six days-pain or no pain. At the end of that time the 
pain and swelling had entirely disappeared. When I was first 
called he was about to make his usual yearly visit to Carlsbad 
and now started East for that purpose. He was detained in 
New York longer than expected, when he felt so much better 
that he postponed the continuance of his trip and returned to 
California. He has now for over three months had no attack, 
and thinks that he is not only free from their frequency, but 
hopes that he has become altogether cured. 
2d-Gout. Mrs. E. H., aet. 50, was subject to occasional at- 
tacks of gout affecting the first joints of both hands, at which 
times the joints would be swollen, hot and painful, and of late 
deflected more or less after each explosion. I was called at the 
beginning of one of her acute attacks. I gave her antipyrine x 
grains every two hours until the pain was relieved; taking fifty 
grains. I then gave her ten grains four times a day for ten days. 
She continued to improve, and at the end of that time all pain 
and most of the swelling was gone. I then ordered ten grains 
once a day for one month, and since then the same quantity 
twice a week. It is now six months since I saw her. She has 9 
had no more attacks; the swelling which had become chronic, 
is removed, and her fingers though not all quite straight, are 
wonderfully improved. It looks as though she had escaped a 
disease which was progressive and becoming markedly chronic. 
3d-Carbuncle. Mrs. T. P., aet. 53, suffering with glycos- 
uria, has had carbuncles before; consulted me about one week 
after the beginning of a recent attack. I found a well defined 
carbuncle on the left side of the back, just above the crest of 
the ilium; the mat portion was three inches long and two and 
a half broad, the center was already assuming a dusky hue 
with several little points, showing beginning of the honeycomb- 
ing process, the edges red and an areolar ring an inch or more 
wide over the surrounding tissue, and the whole thing exceed- 
ingly painful. I did not use the knife as my experience with 
that line of treatment in previous attacks had not been satisfac- 
tory, but used poultices. The next day it was worse; I contin- 
ued the treatment. On the third day she was still worse, the 
mat evidently growing larger, and I began to fear for the ulti- 
mate recovery of my patient. As the pain was very severe (al- 
though apparently contraindicted), I concluded to give her anti- 
pyrine. As an analgesic, simply, it acted promptly. She took 
ten grains every hour until she had taken forty grains. The 
next day in addition to the relief of pain, I found to my sur- 
prise, that the congested areolar had almost disappeared. The 
edges were not as marked, and there was a perceptible shrink- 
ing of the whole abscess. Taking the hint, I gave her five 
grains every three hours, for several days. She continued to 10 
improve, the carbuncle grew smaller, the center suppurated 
and healed rapidly by granulation. The poultices were dis- 
continued, and nothing done but the occasional application of 
spirits camphor, and keeping it well covered with ung. amyli, 
together with nourishing diet and a fair quantity of stimulus. 
4th-Cerebro spinal meningitis. I was called in consultation 
with Dr. C. C. Vanderbeck, to visit a boy of about eleven years, 
whose symptoms pointed conclusively to an abrupt attack of 
this disease. Delirium, opisthotonos, etc., were present. It 
was the second day of the disease, and he was becoming rapidly 
worse. He had been under the usual course of treatment re- 
commended in such cases. We decided to try antipyrine, and 
ordered five grains to be given every hour for several hours, 
and watch the effect. We saw him again the next day, he had 
taken eight doses before any perceptible effect was manifest, 
when there was a marked mitigation of the symptoms. The 
medicine was continued at longer intervals. He continued to 
improve, quieting down, becoming rational and taking food, 
and made a rapid recovery. 
5th-Dysmenorrhea. Miss A. D., hair dresser, aet. 19, had 
been for two years oi' more a great sufferer from this trouble. 
The pain was present during most of the menstrual period, and 
was so severe that she was obliged to remain in bed. Her gen- 
eral health began to suffer in consequence, and she was fast 
becoming a confirmed invalid. Upon consultation, I advised 
the use of antipyrine, and powders of ten grains each were or- 
dered with directions to take two when the pain began, and one 11 
every hour after until six had been taken, if required, and then 
report. At the next period she took the two and one, one hour 
afterwards. She was so much relieved that she did not take 
any more until reporting. She was then told to take one three 
times a day for the rest of her time. She had no further trou- 
ble, and at each period anticipates the pain at the first warning, 
and is able to continue her vocation comfortably. 
I will close this record with these few cases taken from many, 
but they are sufficient to show the value of this medicine in dis- 
eases not usually or readily amenable to other lines of treatment.