NATRUM SALICYLICUM.

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Preparation , Triturations or solutions.

Authority.

Dr. Peterson, Central-blatt. Für Chirurgie, May 5th, 1877 (N. Y. Med. Record, July, 1877), a girl aged fifteen, took by mistake, 26 grammes, between 6 A.M. and 6 P.M. (fourteen days after a resection of the ankle-joint for chronic fungous arthritis).

The patient's psychical condition was very striking, perfectly rational periods alternating with manifestations of insanity of a sombre character. This condition gradually disappeared in about eight days, the rational periods gradually becoming longer. The temperature had no influence on the psychical disturbances.

After her recovery, the patient remembered nothing that had happened during this entire period. In her rational intervals, she complained of severe headache, ringing in the ears, deafness, and impairment of vision for distant objects. For three or four days there were strabismus divergens and marked mydriasis; for four or five days there was hoarseness, but as a laryngoscopic examination could not be made, Dr. Peterson is unable to say whether it depended on laryngitis or on paralysis of the vocal cords.

The respiration was rapid (forty per minute), but inspiration was quite deep. The pulse varied independently of the temperature, being at one time between 120 and 130, and at another between 80 and 90. The salicylate of soda did not, in this case, exert a prompt influence on the temperature.

Circumscribed spots of vascular dilatation, which changed their position from time to time, were observed on the face, neck, breast, and leg; these lasted for three days. A bed-sore rapidly formed on the sacrum, and was ascribed by Dr. Peterson to the vaso-motor disturbances. There was vomiting, but no gastric pains; no diarrhœa, but a very fetid smell to the fæces. The urine contained at least one-fifth per cent. of albumen, which gradually disappeared. There was no œdema of the legs. The treatment was symptomatic. Bromide of potassium was administered. During the subsequent two weeks, traumatic erysipelas set in on two occasions, but was arrested by subcutaneous injections of Salicylic acid. After the last injection, symptoms of poisoning (redness of face, dilatation of pupils, frequent respiration, pulse 130, etc.), set in, although the dose was very small centigrammes. solution = 2 centigrammes. acid).

SUPPLEMENT: NATRUM SALICYLICUM. Authorities.

2 , Brit. Med. Journ., quoted by the Review, p. 376 (Hahn. Month., vol. xiii, 1877, p. 56); 3 , A. D. L. Napier, M. B., Practitioner, vol. xviii, 1877, p. 411, an old gentleman, for rheumatic affections of the wrists and ankles, took 20 grains every three hours for more than a week; 4 , John A. Erskine Stuart, ibid., p. 425, effects of a 15-grain dose; 5 , Weckerling, Deutsche Archiv für Klin. Med., vol. xix, 1877, p. 319, a woman, who had formerly suffered from hæmoptysis and pleuritis with effusion, and now continued to have fever, took several evenings 5 grams at a dose, but this day took 15 grams, at 1 P.M.; 6 , Hemblein, Ærz. Intell. Blatt., April, 1878 (Lond. Med. Rec., May, 1878, p. 211).

• Urine passed after three hours kept fresh and free from ammoniacal odor, and perfectly clear when exposed to the air for ten days, 4.
• The patient was a woman, aged forty years, whose hearing was supposed to be impaired. She was not subject to giddiness. It was her first attack of acute rheumatism, and there was no cardiac affection. On January 26th, Salicylate of soda was commenced in doses of 25 grains every three hours. On the 28th she complained of noises in her ears, deafness, and giddiness, which the next day had increased so much that the drug was omitted. The following day the giddiness was much less, and by the 31st had almost gone. On February 6th the same dose was resumed; on the 7th the same symptoms were complained of. The noises in the ears were constant; a watch was heard only at two inches distant from each ear, and was not heard at all on either side when in firm contact with either zygoma or mastoid process. A tuning-fork on the vertex was heard fairly well, but the sound was not increased by closing the ears. The giddiness was slight and indeterminate as long as she lay still, but was very considerable and definite when she raised her head or sat up. Objects before her all seemed moving to the right. On the 8th these symptoms continued, and the Salicylate was discontinued. On the 10th the giddiness was gone, and she could hear the watch at a distance of six inches from each ear, and could hear it, although faintly, in contact with the zygoma or mastoid process, but not when in contact with the parietal eminence. On the 23d the Salicylate was resumed, and eighteen hours after its resumption deafness and giddiness had returned, which again ceased a day or two after discontinuance of the drug. When the patient was convalescent, a careful examination of the state of hearing revealed very little abnormality, the only difference being that the watch in contact with the skull was not quite so distinct on the right side as on the left. In another case I have seen similar symptoms of deafness and definite vertigo produced by Salicylic acid, 2.
• Vomiting; unconsciousness, with at times wild delirium, from which she recovered with loud cries; great heat; dyspnœa; difficult hearing (after two hours); pulse 120 (the previous day it had been 92). The most remarkable symptom was the respiration; it was somewhat slower than it had been before, being now 28, while the day previous it was 32; respiration was so noisy, that it could be heard in the street; when the dyspnœa was most violent she had to be supported in a half sitting posture, gasped for air; respiration was exceedingly forcible; there were no objective signs of dyspnœa, like retraction of the chest, of the clavicular fossæ, or of the hypochondria; the respiration continued so difficult that it was surprising that a patient so weak could breathe with such force. Diarrhœa; great thirst; difficult hearing (second day); no sweat (first and second days), 5.
• C. K., a house painter, aged forty-five years, had rheumatic inflammation of the elbow and knee-joints. The pulse was intermittent throughout the course of the case, raising the suspicion of a fatty heart, which was further indicated by the pasty appearance of the patient, and by his acknowledged addiction to alcoholic liquors. During the first ten days, Salicylate of soda was given in hourly doss of 7.7 grains (0.5 gram) without any effect. There-upon the dose was increased to 60 grains (4 grams), with the following result. Soon after this first dose was given, there came on intense tingling and itching of the skin. The left side of the face, the lower extremities, and the right side of the chest were diffusely reddened, while both eyelids, the upper lip, and a great part of the legs were slightly œdematous. The pulse stood at 90, temperature at 101.8° F., and the urine was slightly albuminous. At the same time all pain in the affected joints had vanished, and they could be moved freely about. By the next morning the redness had disappeared, and the pulse and temperature had fallen respectively to 80 and 100° F. In order to ascertain how far these symptoms were the result of the treatment, it was determined to repeat the dose at the next opportunity. The patient continued free from pain for the next three days, but on the fourth day the articular pains returned with such severity that the patient himself begged for "the large powder." 60 grains were given; after fifteen minutes severe burning pain in the frontal integument supervened, and five minutes later strong itching on the back of the right hand. In half an hour a marked eruption of urticaria was established over the greater part of the body, especially the legs and abdomen, with some œdematous swelling of the arms, eyelids, etc. This disturbance moderated in the course of two or three hours, and had completely subsided the next day. Subsequently, several smaller doses were administered without producing any of the above effects, and the patient recovered. After his recovery the patient consented once more to take the larger dose, and the result was precisely the same as before, .