Benefits and Toxicity of Phenylbutazone (Butazolidin®) in Rheumatoid Arthritis

Abstract

erans. It would seem appropriate in this Halsted centen¬ nial year to urge the medical profession at large to interest themselves in the preservation of the residency training program. Some say, and I think with truth, that the stature of Halsted has grown with the passing of years. Perhaps the same might be said of most truly great persons. It should not be thought, however, that he was not appreciated in his lifetime. He was an honorary fellow of many surgical organizations, including the Royal College of Surgeons of England. Professor Leriche of France published a beautiful tribute to him in 1914, eight years before his death. He was a member of the National Academy of Sciences, the only other surgeon in this organization at the time being Harvey Cushing. The National Dental As¬ sociation of America gave him a gold medal in recogni¬ tion of his work on neuroregional anesthesia. He must have been very happy in his accomplishments when his life ended in 1922. The president of the Johns Hopkins University, Frank J. Goodnow, stated at that time, "It is only characteristic of the man that when he died he not only left us the lustre of a name that will always be hon¬ ored by Hopkins men, but as well made the University his residuary legatee in order to enable it more ade¬ quately to carry on the work which he had so auspiciously begun, namely, research in surgery." I am sure Halsted would be pleased that recipients of the Halsted Fellow¬ ship have made significant contributions to surgery.In closing I should like to quote from two tributes to Halsted that appeared shortly after his death. The first is by his brilliant pupil, Harvey Cushing, who wrote, "A man of unique personality, shy, something of a recluse, fastidious in his tastes and in his friendships, an aristocrat in his breeding, scholarly in his habits, the victim for many years of indifferent health, he nevertheless was one of the few American surgeons who may be considered to have established a school of surgery, comparable, in a sense, to the school of Billroth in Vienna. ... He had that rare form of imagination which sees problems, and the technical ability combined with persistence which en¬ abled him to attack them with promise of a successful issue." The second tribute is by his close friend, the be¬ loved Dr. Rudolph Matas, who said, "Modest, self re¬ pressed, shunning the limelight of publicity, he never ob¬ truded his personality or exploited his deeds and only referred to himself in the most impersonal way, allowing the facts always to speak for themselves. . . . Though shy and reserved and undemonstrative, he delighted in the company of his pupils, immediate associates and a few chosen friends. With these he was expansive, and the glow and warmth of his friendship rapidly dissipated whatever restraint might first have been imposed by his punctilious politeness and adhesion to conventional formalities. To those who were privileged to bask in the sunshine of his friendship, the true nature of the man was revealed in all its splendor."Were Halsted ...

Toxic Effects of Phenylbutazone

“…Thus Peebles-Brown and Currie (1952) described only five toxic effects out of 280 patients (an incidence of 1.8%). On the other hand, Cudkowicz and Jacobs (1953) reported an incidence of 52%, and Stephens et al (1952) one of 44%. Details of the 356 reactions in 1,526 patients have now been reported-an average incidence of 22%.…”

“…Thus Stephens et al (1952) reported a fall in haemoglobin of 1 g. per 100 ml. or more in 18 out of 188 patients, and a fall in the platelet count below 100,000 per c.mm.…”

Pharmacokinetics, pharmacodynamics, metabolism, toxicology and residues of phenylbutazone in humans and horses

“…In the period of early use after its introduction in 1949, the incidence of adverse haematological effects, with a phenylbutazone dose rate of 1 g per subject daily, was higher than subsequently (dosage of the order of 300-600 mg); in a study of 188 rheumatoid arthritis patients, 16% developed thrombocytopenia and 10% developed anaemia (Stephens et al, 1952). von Rechenberg (1962) reported 51 deaths and 38 non-fatal cases of agranulocytosis linked to phenylbutazone usage from an estimated population of 50 million treated humans.…”

Zur Behandlung der aktiven Lungentuberkulose mit Butazolidin

“…G ru p p e m it m a n g e lh a fte m B u ta z o lid iu e ffe k t), is t hier ein v o rw ieg en d e u p h o ri sch er E ffe k t a n z u n e h m e n , w ie er b e re its von K uzell [18] u n d von Stephens u n d M ita rb e ite rn [28] als n eurologische, a b e r m eist h a rm lose N eb e n w irk u n g des B u ta z o lid in b eschrieben w urde. E in e Z u n a h m e v o n IN H -N e b e n e rs c h c in u n g e n h ab en w ir u n te r B u ta z o lid inb e h a n d lu n g n ic h t b e o b a c h te t; in sg e sa m t w aren es n u r 4 P a tie n te n , bei d en en I N H -P a ra e s th e s ie n a u f tr a te n , die n a c h U m se tz e n a u f ein an d e re s T u b e rk u lo s ta tic u ra in K ü rz e w ieder ab k la n g e n , oh n e d aß die B u ta z o lid in -M c d ik a tio n u n te rb ro c h e n w erden m u ß te .…”