"The Druggist's
Duty Concerning Coal Tar Derivatives" by F.M. Siggins, from the Dixie
Druggist, May 1913, online at UNC Health Sciences Library. Acetanilide, also
known as phenylacetamide, acetalil, acetanilid, and Antifebrin, is no longer
sold as a drug. It was found to reduce pain and lower fever and introduced
under the name of Antifebrin in 1886. Unacceptable toxic effects prompted the
search for a less toxic aniline derivative, such as phenacetin. After several
conflicting results over 50 years of study, it was found in 1948 that
acetanilide was mostly metabolized in the body to paracetamol, which is
acetaminophen. Of course, acetaminophen is still sold today, but there is a
risk related to high doses of the drug. The FDA today warns that acetaminophen
doses over 325 mg might lead to liver damage. Large doses prescribed in 1913
and the fact that acetanilid contains other potentially dangerous substances
that are not found in acetaminophen are probably behind the harm suffered by
patients in the following story.
I am not a
physician, I am even ignorant of the simplest forms of disease which many
druggists are familiar with, and my excuse for the ignorance is, that I have
studiously avoided that line of study that I might have less incentive for the
so-called art of counter prescribing.
But if I am weak in
the knowledge of disease, I hope I have not spent 30 years behind the drug
counter without using my facilities of observation, and in as short a time as
possible, I wish to register my emphatic objection to the further open sale and
use of coal tar derivatives, and I follow with my reasons.
My first notice of
their danger was brought to me 25 years ago, in the early days of Acetanilid,
by a physician who gave large doses and was enthusiastic over the results and
saw no harm in its use. A few months later I noticed that the doses had been cut
down 60 per cent, and I enquired the cause. "Well," says he, "I
nearly killed half a dozen of my best friends, and I thought it time to
stop."
As the years rolled
on, scarcely a month passed by but what some incident occurred that told me we
have admitted into common use the most dangerous drugs ever placed upon the
pages of our text books. I have taken 1 1/2 grain doses of acetphenetidin with salol
at various times for colds and rheumatism, and thought for years that it did me
no harm, but now I am reluctantly compelled to acknowledge the contrary. For
after two or three days' use, with a dosage of 1 1/2 grains three or four times
a day I find myself almost completely benumbed and heart action very weak. And
as I recall it I have always had these symptoms, though less pronounced, and
yet it has taken years, with all my knowledge of the drug, to tumble to its
viciousness. A physician very near to me commented using the same drug in small
doses and in a short time could take as high as one dram, but he has quit. Here
are the two extremes in dosage.
Another physician
gave a colored woman the well-known mixture of soda acetanilid and caffeine and
in a short time she was consuming one ounce every two weeks. The physician and
the woman are both dead.
Still another M.D.
who dispensed about 1,000 3 1/2 grain acetanilid tablets per month died with a
bad heart. I do not know how many of them he took himself, but I have always
had my convictions, and I am reasonably certain he died without blaming acetanilid
for his condition. Our sales for one
year covering our retail trade and wholesale account of about 100 physicians
totals 100,000 tablets containing some one of the coal tar products. The patent
headache and pain remedies, estimated in 10 cent packages, total 4,000 and the
cold cures 700 boxes, while the bulk goods, covering acetanilid,
acetphenetidin, hexamethylene, sulfonal, trional, veronal, reaches 15 pounds.
The profit on these goods should run about $400, but the public is welcome to
any part of it, if they will let coal tar alone, either voluntarily or by
compulsion. Now then, with these figures before us and with the facts plainly
evident to druggist or physician who uses any powers of discernment, what
change have the common people against the wiles of the impertinent manufacturer
who repeatedly advertises "Perfectly Harmless."
I must now give you
the cases which aroused in me the antagonism to the open sale of all remedies
which contain any coal tar derivative, no matter how strongly fortified with
correctives.
A close friend of
mine had a young son come down with a cold, the physician prescribed 20
powders, two grains each of acetphenetidin. Some time after this, the box came
back for a refill. I said to Jones, "Does the doctor want you to have
these again?" He replied that he did. This happened several times in the
course of a few years, and the boy became old enough to come to the store
himself on errands, and I could not help noticing how white and pale he was,
and it finally dawned on me what ailed that boy. I went to Jones and said to
him, "While it is none of my business, I want to tell you with all the
force possible, to quit killing that boy." "Well," he says,
"I told my wife what you said, and she replied that she guessed the Doctor
knew as much as I did about it, so he had dropped it, but now I believe you are
right, and those powders stop right here." The boy today is a fine
strapping rosy-cheeked youth.
A young man of this
town, a perfect giant in strength, who could pick up my 175 pounds and throw me
over his head, became addicted to the use of one of our popular effervescent
preparations for headache. Some time after he commenced using it, I began to warn
him against the frequent dosage, till he almost quit coming to our counter, not
relishing my "preaching" as he styled it. I saw him, however, at all
the other stores in town, and knew he was using it regularly. Several years
passed, and some prescriptions containing heart remedies were ordered sent to
this man, later a nurse was called. I asked the physician "What ails
Brown?" "Heart trouble," says he. I told him what I knew, and he
thanked me, not knowing the cause.
In a few days this
perfect specimen of physical manhood died--died in the prime of life and with a
strength that not one man in 10,000 ever attains, died because we men,
druggists, doctors, and scientists have been so slow to recognize the slow,
sneaking, insidious character of these vicious remedies. No one can make me
believe, when I pick up the morning paper and read the same old story day after
day, that Jones dropped dead in Texas, Smith in Main and Black in California,
that Coal Tar was not at the bottom of 90 per cent of them.
For my part I am in
this fight to stay. I have decreased our sales by one half, by my own warnings
against their use.
But how much avail
am I to the ignorant young rounder who comes out of a night's debauch with a
big head and who still half drunk wanders from drug store to drug store and
asks for his effervescent? No one guilty because the busy clerk or proprietor
did not know that he had had another just 5 minutes previous. With all this
knowledge before me I have been guilty of openly pushing the sale by the
distribution of literature lauding these remedies, but no more for me.
And I ask my brother
druggist not put out any advertising which may contain on one of its pages a
recommendation for a coal tar remedy. I also hope to soon see upon the statues
of every State a law similar to the one concerning Cocaine of our own State.
For I maintain that
Opium or Cocaine are not one half as deadly as Coal Tar, for while they openly
show what they can do, the other works silently till the end is near. For our
part, we have quit putting up a remedy of our own, and I have in mind the adoption
of a label to go on the outside of all packages sold, to read something like
this:
"All remedies
containing acetanilid, acetphenetidin or the like product of coal tar are
dangerous and should be used with caution, in extreme cases only, and never
habitually.
Considering the effect on myself, on the people I have sold to, the evidence of
many physicians who have found out the pernicious effects and felt themselves
compelled to abandon or modify its use, I venture the opinion that, while it is
bad medicine for any one for regular use, on those who are extremely
susceptible to it, it soon vitiates the blood and deprives them of their full
powers of resistance, when sudden shock or disease o'er takes them.