Read by title before I.H.A., Bureau of Materia Medica, June 18, 1940.
ALLAN D. SUTHERLAND, M.D.
For five years Sulfanilamide has made the headlines of medical news, not only because of the startling cures assigned to its actions, but also because of the no less startling by-effects attributed to this drug. As physicians we are interested in the cures, but as homoeopaths we should be equally interested in the by-effects, because the latter represent a rather crude pathogenesis of Sulfanilamide.
Ever since para-amino benzene sulfonamide, or Sulfanilamide, came into general use as a therapeutic agent I have had a desire to make a proving of this substance. When Dr. Roberts asked me last fall to prepare a paper for the Bureau of Materia Medica, I determined to begin this project and to report my findings to this Bureau. Through the kindness of Boericke and Tafel of Philadelphia I was able to obtain Sulfanilamide in the crude form and also in the 3x. and 6x. triturations. The crude Sulfanilamide powder was manufactured by Merck & Co. and the triturations made from that. Dr. Roberts supplied me with the 200th, also prepared by Boericke and Tafel.
There was some difficulty in finding provers, but eventually a man and a woman volunteered and the proving was begun.
The first prover, a man aged 23, was given given five grains of crude Sulfanilamide at 10:30 a.m. on January 4, 1940. At 11:30 a.m. he began to experience pain in the belly of the right triceps muscle which he described as lameness. The lameness was < on beginning motion of the part and was > by rest and by continued motion. At the end of two hours the pain was gone.
The same prover was given some tablets of the 6x. trituration with instructions to take one tablet every two hours until he noticed symptoms, then to take no more as long as symptoms were present. He began taking the drug on January 17, 1940 at 3 p.m. No symptoms were experienced up to nine oclock at which he went to bed. On rising in the morning on January 18 he experienced the same pain in his right arm as previously described with > from exercise.
He began to take the drug again at 7 a.m. and continued its ingestion until 9:30 p.m. About 3 p.m. he noticed a dull ache in the back of his head accompanied by ringing in the ears. The latter continued about a minute and was followed by a sensation as if the ears were stuffed up. The dull ache in the back of right head lasted for two hours and was relieved when he went into the fresh (cool) air. He stated that the stuffy feeling in the ears was relieved at the same time. On January 19 he started the drug at 12:40 p.m. and thereafter “each two hours that afternoon”.
On retiring in the evening of this day he complained of an ache in his shoulder which seemed to proceed up the back of his neck and was worse when lying down. The next morning he complained of stiffness in the right arm with lameness and < from raising the limb above his head. This symptom was worse on this occasion than on others. He further stated in his report to me, “On the fourth day (Jan. 20) after I took the first dose, I noticed a bruised spot on the front of my body by my shoulder, this may have been caused by exercising too much on the bowling alley previous to taking the medicine.”.
The same prover was given the 3x. trituration on another occasion but developed no symptoms from it.
On one occasion I took one tablet of Sulfanilamide 3x. Fifteen minutes later I experienced a peculiar taste in my mouth. This taste was similar to that noticed when one is working in a chemical laboratory where the air is impregnated with the fumes of hydrogen sulphide.
On another occasion I took the 3x. in the following manner: One tablet at 10 a.m., 2 tablets at 11 a.m., 4 tablets of 12 noon, 6 tablets at 2 p.m. Symptoms were noticed after the first and second doses, but none thereafter. About three minutes after the first dose there appeared a sensation of lightheadedness, not a real vertigo. This symptom was < by smoking and disappeared in the open air and was > when thinking of other things. Soon after the second dose there appeared a prickling sensation on the tongue, as if fine needles were touching it.
This sensation lasted for less than five minutes. No further symptoms were experienced with the drug.
The female prover, a young woman of 29, was given the 6x. trituration of Sulfanilamide and later the 200th. The trituration was given as follows: One tablet every two hours until symptoms were experienced. The 200th was given in a single dose.
In this case the proving of the 6x. was begun on January 26 at 2 p.m., one tablet being taken every two hours until 10 p.m. She stated that in the morning of this day, before beginning the proving, she felt as if a cold was coming on but that all those symptoms had disappeared by noon. The same symptoms were experienced in the morning of January 27, but were not present on the 28th or thereafter. I do not believe these symptoms were due to the Sulfanilamide, nor do I feel that they were cured by the drug. Between January 26 and February 2 a total of 60 tablets of Sulfanilamide 6x. were taken.
There were only two manifestations that might be attributed to the action of the drug. The first of these appeared in the afternoon of February 2 and was described in the provers notes, as follows: “This afternoon my right leg ached just as it does a rule after my period starts.” The second symptom which might be taken as due to the action of Sulfanilamide was noted by the prover, as follows: “Saturday, the 3rd (Feb.) period started, the same as any, but not as much flow the first few days.”.
The results of the proving with Sulfanilamide 200 are very interesting. They were almost all referred to the skin and lasted from the first of March until the last of May, a period of nearly three months. The proving began on February 27 when she took a dose of Sulfanilamide 200 before breakfast. No symptoms appeared until March 1 at 4 p.m. at which time she began to experience aching from small of back down the legs to the ankles. There was aching pain in the lower abdomen accompanied by bearing down in the pelvis. At five oclock she felt as if the period had started (the period was due). All these symptoms had disappeared by 9 p.m.
The menses did not appear until March 3 but apparently were influenced to some extent by the drug. The prover describes the effect in these words, “… the flow wasnt as great as the whole thing was shorter by two days.”.
Now follows a period of quiescence lasting until March 13. But on this date begins a series of skin manifestations that lasted until May 29. From March 28 until May 20 there was another period of quiescence. Strangely enough, all the skin symptoms were confined to the region of the face: nose, eyelids, eyebrows, chin and angle of the left jaw. The actual eruptions were manifested as pimples, pustules, moist, scabby sores and styes. On three occasions during this time the prover felt as if a cold in the head would appear, but instead of a cold an eruption would appear. At each menstruation she would have a red pimple at the angle of the left jaw.
This has now disappeared but there is a brown scar at the site. Almost all the skin symptoms were distributed to the left of the midline. All the skin manifestations were > by hot applications, < by touch or pressure, during menses, and after taking cold. The sensations produced were burning, soreness, prickling and pulling. The discharges from the skin lesions were watery (serous), yellowish pus or bloody pus. Accompanying the stye on the left lower eyelid at the inner angle there were pricking pains “like pins all around eye”, swelling of both lids, sclera “very bloodshot”.
An attempt to compare the toxic effects of Sulfanilamide with the symptoms resulting from these provings in my opinion in useless. Symptoms due to poisonous drug-effects are as coarse and crude as the substances which have produced them. The finer and distinguishing characteristics of drug action are only brought out when proved in attenuated form. I believe that the results obtained in this very imperfect and incomplete pathogenesis prove that the greater the attenuation, the more pronounced are the symptoms produced in the provers.
I believe there is more work to be done on Sulfanilamide: three provers really prove nothing. The symptoms I have obtained should be confirmed from other sources, and more added.
I am appending a Schema which is composed of the symptoms produced in my provers plus the toxic manifestation, gathered from various sources, which have appeared in patients under treatment by the crude drug. Toxic symptoms are marked T; those from the proving are marked P.
Loss of memory, accompanied by deafness. T.
Sensation similar to alcoholic intoxication. T.
Lightheadedness, as if drunk. T.
Lightheadedness, aggravated by smoking, ameliorated in the. open air and when thinking of other things. P.
Dull ache in the occiput with ringing in the ears, better. in the open air. P.
Fullness and heaviness, as if cold would appear,. aggravation in a.m. P.
Pustules on forehead. P.
Soreness of the forehead. P.
Hard, red pimples with yellow tips on right eyebrow. P.
Red swelling on margin of left lower lid at inner angle. P.
Stye at inner angle of left lower lid covered with several. small yellow pimples. P.
Left sclera “very bloodshot”. P.
Sensation about left eye as from “little pin pricks”,. especially on inner angle of lower left eyelid. P.
Swelling of both upper and lower left eyelids accompanying stye. P.
Ringing in the ears accompanying dull ache in the occiput. P.
Stuffiness in the ears, relieved in the open air. P.
Scanty, water discharge in the morning. P.
Yellow pimples on insides of left nostril. P.
Scabby sore on inside of left nostril which discharges bloody serum, worse when blowing nose. P.
Stinging over bridge of nose in the morning. P.
Red swelling on left side of bridge. P.
“Sore” on edge of left nostril covered with soft, yellow scabs, which discharges serum or blood. P.
Similar sore on edge of right nostril. P.
Pimples on the nose. P.
Smarting and burning of “sore ” on nose, worse from.
touch; better from heat and when discharging. P.
Pustules on the forehead.P.
Soreness of the forehead. P.
Pimples on cheek near left nostril. P.
Red pimple behind angle of left jaw, soreness, appeared during menses and after taking cold. P.
Sore, red pimple on chin. P.
Brown, pigmented spot behind angle of left jaw after pimple and healed. P.
Peculiar taste in mouth as after inhaling hydrogen sulphide. P.
Prickling sensation on the tongue, as if fine needles were touching it. P.
Nausea and vomiting. T.
ABDOMEN AND STOOL.
Colicky abdominal pains. T.
Aching low down in pelvic portion of abdomen, as if menses would appear. P.
Bearing down sensation in pelvis. P.
Sensation in lower abdomen as if menses had appeared. P.
Hepatitis and jaundice. T.
Slowing of and loss of force of urinary stream. T.
Micturition difficult. T.
Menstrual flow less than usual. P.
Period two days shorter than usual. P.
Before menses: Aching in back and down legs to ankles; bearing down in the pelvis; aching in pelvic region; sensation in pelvis as if menses had appeared; aching in right leg. P.
During menses: red, sore pimple behind angle of left jaw. P.
Persistent dyspnoea. T.
Pain in the chest. T.
NECK AND BACK.
Aching in the back of the neck coming from the shoulder, worse when lying down. P.
Aching in the lower back before menses. P.
Lameness in belly of right triceps, worse on beginning motion, better from continued motion and from rest. P.
Stiffness of right arm in the morning with lameness, aggravation from raising arm above head. P.
Aching from lower back down legs to ankles before menses. P.
Aching in right leg before menses. P.
Aching in shoulder (right) proceeding up back of neck, worse when lying down. P. Tingling and numbness of hands and feet. T.
Muscular weakness. T.
Numbness and tingling of hands and feet. T.
General malaise and lassitude. T.
Easy fatigue. T.
TEMPERATURE AND WEATHER.
Amelioration in open air. P.
Amelioration from hot applications. P.
Morbiliform eruptions. T.
Eruptions on exposure to sunlight. T.
Skin of lower extremities sensitive. T.
Sore, red pimples. P.
Sore with soft, yellow scabs, exuding bloody moisture. P.
Yellow Pimples. P.
Scabby sore, burning and smarting, better from hot applications and when discharging. P.
Sore, red pimple behind angle of left jaw which appears during menses and after taking cold, and leaves a brown spot when healed. P.
Hemolytic anemia. T.
Lowering of the blood-plasma carbon dioxide-combining power. T.
Sulfhemoglobinemia and methemoglobinemia. T.
Toxemia, resembling that of ethyl alcohol. T.
Severe toxemia with fever and rapid pulse. T.
Optic neuritis. T.