NATRUM SALICYLICUM.
Sodium salicylate, NaC7H6O3 + H2O.
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, [6].
► Became very deaf, had ringing noise
in the ears; severe headache; thirst; loss of appetite; felt dull and
heavy, [3].® 2000
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