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Not Infrequently a Little Or Much Below Normal; the Re- Tinal Tract results. Peristalsis was not increased, and there was no Marked chronic bromid intoxication is a not infre- defecation even when the dose was increased to cause quent occurrence and the very mild, often not recog- acute nephritis. nized, forms exceed in frequency the more severe. To Of the salts, sodium sulphate increased peristalsis and diagnosticate the mild types is of special importance. produced watery discharges in all the animals experi- For a number of years the bromids have occupied first mented on. The same results were obtained in the con- place among the numerous drugs prescribed for the epi- trol experiments. Sodium phosphate acted similarly to leptic. Though given in a large number of maladies and sulphates, but it did not increase as markedly the peris- pathologic conditions, no disease enjoys its use to such talsis of the stomach. Sodium chlorid in small doses an extent as epilepsy. A large number of the nostrums, was negative as to increase of peristalsis ; in larger doses placed before the public by irregulars and professional it produced a toxic gastritis. pretenders, for convulsive and other nervous conditions, Nux vómica did not increase peristalsis either in rab- contain potassium bromid as one of their chief ingre- bits or cats, whether observed under «-rays or kept in dients. saline solution. Control animals also gave negative re- Spratling analyzed some thirty "patent medicine" sults with this drug as to defecation. preparations on the market, so-called cures for epilepsy, From we these results may hope that aloes and podo- and potassium bromid was found to be the chief ingre- phyllin like the salts may be useful in atonic conditions dient of each. To them can be ascribed a large amoun* of the stomach. of injury of which those afflicted with fits have received DISCUSSION. much the largest share, for their victims are peculiarly Dr. H. C. Wood, Jr., Philadelphia, said that it is not at all cer- to the for a trouble tain that the intestines of the rabbit do susceptible glowing promises appar- react as the intestines ently so desperate and discouraging. The of man. In fact, there is reason to believe that the intes- epileptic, strong an chronic sooner or tines of the rabbit are not a criterion for those of the human carrying extremely burden, acquires later a more or less defective and ; being. It is known that, in general, purgatives act very differ- perception judgment he has inherited a weakened nervous or acts on ently on lower animals than they do on human beings. Espe- system cially is this so in the dog. It must also*be so in the rab- the advice of a parent or guardian whose judgment is bit on account of the very different development of the intes- not infrequently a little or much below normal; the re- tinal tract. The rabbit's food is entirely herbivorous and sult is he becomes an easy prey for medical grafters. contains a large amount of indigestible residue, and the in- Even the more conscientious licensed can testine of the to practitioner rabbit is made accommodate this food; and does make errors in the care of these per- whereas man's food is much more concentrated and man's in- patients, careless or too visits. testinal tract is made for a different and it is there- haps by infrequent Often, too, purpose, the himself or those be indiffer- fore only reasonable to that the intestines of man patient responsible may suppose ent. react somewhat differently from those of a rabbit. Dr. Wood thinks, therefore, that any conclusions based on experiments Bromids have a place whose limitations are well de- on rabbits must be accepted with some caution as bearing on fined in the treatment of epilepsy and other nervous dis- the human being. orders. Besides epilepsy, the drug has been used in There is çne drug, he said, which might have been well nervous exhaustion following excessive mental or physi- studied with a great deal of benefit to the profession, that cal neuralgia, delirium tre- is It is the most stimulant of non- labors, migraine, hysteria, physostigmine. powerful mens, in noc- striated muscle. In or intestinal this pertussis, tetanus, spasms children, pavor gastric atony drug is of turnus in acute great use. childhood, laryngismus stridulus, laryn- to alleviate or in Dr. F. Ppaff, Boston, stated that he used cats as well as gitis, spasms pain throat examinations, rabbits. Cats gave the best results with the »-rays. Rabbits passing stomach tube, catheter or sound, vomiting of did not give good results with the ¡r-rays, except when pregnancy or uterine diseases, dysmenorrhea, menorrha- fed for weeks on bread. As to physostigmin, he mentioned gia, nymphomania, satyriasis, masturbation, seminal a research published last year. In Schmiedeberg's laboratory emissions, gonorrhea, chronic alcoholism, morphio- Heubner made on himself with to experiments physostigmin mania, nausea marina, cinchonism, strychnin poisoning, see how it would influence the intestinal tract. He also en- and other mental and In services of physical disorders. many of listed the a few associates, who, as they were these disorders chronic bromid intoxication is medically trained and knew what they were taking, improb- promptly responded by free evacuation of the bowels. In the able, since they are of short duration or only one or two a Strassburg medical clinic, Heubner's experiments were re- doses are prescribed at time. peated on patients with only one positive result. In all the BROMIN PREPARATIONS. other cases the patients complained of nausea, giddiness, ten- sion in the head, profuse sweating and even vomiting, but Only a few years after the discovery of bromin, in defecation did not take It place. seems, therefore, that 1826, by Balard, was the chemical or its salts used as a can not be used at all to stimulate physostigmin peristaltic Potassium bromid was in- movements in human beings. therapeutic agent. primarily troduced as an alterative and resolvent to substitute the iodid salt. The class of cases for which it is recom- mended was completely changed after its sedative action BROMISM: WITH A REPORT OF CASES. became known. According to Binswanger, Lolock, in A. L. SKOOG, M.D. 1853, first brought the bromids into the foreground as a First Assistant Physician, Kansas State Hospital for Epileptics. drug to be used especially in the treatment of epilepsy. PARSONS, KAN. There are now on the market over 40 bromid prepara- to This paper will deal largely with a problem of bromid tions supposed have some therapeutic value. Of these, we need consider a few. From our stand- therapy drawn from observation and the literature on seriously only of toxic action, a number of the bromates and com- Under the term bromism we include all the point epilepsy. pounds would not be placed in the same class as potas- various toxic manifestations resulting from the con- sium bromid and similar salts. tinued use of any bromid or chemical with a large per- Potassium Bromid.—Potassium bromid, used in much centage of bromin. greater quantities than all the rest of the bromids com- Downloaded From: http://jama.jamanetwork.com/ by a Oakland University User on 06/07/2015 bined, contains 67.15 per cent, of bromin. Its basic ele- papules, pustules, superficial and raised ulcers, and pa- ment itself is much more toxic than those of most of the pillomatous tumors. Twenty-three minims had been other salts. The depressant action of potassium on the given over a period of 25 days. An inadequate knowledge circulatory organs must also be taken into consideration. of the toxicity of bromotone (tribromtertiarybutylalco- It is not an easy problem to determine exactly how much hol), bromocoll, bromipin and bromalin exists. damage the basic element of potassium bromid has done After reviewing the various preparations containing to the epileptic. For most of the grand mal seizures bromin, their toxic action can not be entirely ascribed to must of themselves throw a severe strain on the circula- the halogen element. We are safe in largely attributing tory apparatus. In postmortems on a number of epi- the toxicity of the metallic salt to the combination as leptics dying at the Kansas State Hospital for Epilep- such and not to any one of the individual elements tics a very large percentage presented hearts and blood separately. These salts seem to be absorbed as such, car- vessels with marked pathologic alterations of a chronic ried to all tissues and assimilated by the cells with some type. Becently a report from the New York State Epi- special predilection for certain groups. Doyon has re- leptic Colony appeared with a series of autopsies that ported a postmortem on an epileptic who had been tak- gave a high percentage of chronic cardiac lesions. ing potassium bromid for a number of years. The drug Sodium Bromid.—Sodium bromid is a salt second in was found in all the organs, but chiefly deposited in the favor, containing 77.62 per cent, bromin. The 10.47 per brain. cent, excess of its bromin over At the Kansas State Hospital for Epileptics when a the potassium salt might , bromid indicated the sodium salt is now used. indicate greater toxicity, but the reverse is true. Sodium is largely used to a extent at salts, as a rule, are less toxic than Potassium bromid has been great potassium. Expe- extensive has been the tribromid rience and experiments on dogs teach that it is better times. An trial given of sodium and with no better re- tolerated by the mucous lining of the stomach and intes- potassium, ammonium, tines. On several occasions I have given large single sults than from one salt.
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