Kali Bromatum

Potassium bromide.

Preparation, Triturations.

Authorities. 1, Dr. Hering, Inaug. Diss., Tubingen, 1838 (Hygeia, 8, p. 547), took daily doses of 1 grain, afterwards increased; 2, Dr. Herrnerdinger, Inaug. Diss., Tubingen, 1838 (Hygeia, 10, 449), took ^ drachm in water, fasting, and afterwards 1 drachm in six divided doses” during one day; 3, Otto Grief, De Kali bromata., Leipsic, 1840 (A. H. Z., 19, 126), took of a solution daily doses, afterwards increased and repeated; 4, same, M. M., a man, 22 years old; 5, same, R., a man, 26 years old, effects of larger doses; 6, same, K., 24 years old; 7, same, L., 32 years old; 8, same, M., 27 years old; 9, same, M., 27 years old (another prover); 10, same, S., 25 years old; 11, same, B., 28 years old; 12, Bowditch, Boston Med. Jour., Oct. 1868, effects of 30 grains, experiment on a medical student; 13, Rabuteau, Gaz. Hebd., April 24th, 1868, experiment on self with 1 gramme (dissolved in water); 14, Labored, experiment on self with 15 grammes, taken twice, Gaz. Med. de Paris, 1869, p. 553; 14 a, same, effects of 6 to 8 grammes, repeated once after a quarter or half an hour; 15, Bill,- Am. Jour. Med. Sci., N. S., 56, 17, experiment on one individual (effects on urine); 16, Hamburger, experiment on self and other physicians with 218 grains of pure drug, taken between 2 and 3 p.m., Practitioner, Jan. 1874; 17, Nicol and Mossop, observations on selves by ophthalmoscope on eight occasions after doses of 10 grains to 1 drachm, Brit, and For. Med.-Chir. Rev., July, 1872; 18, Huette, general effects of doses of 10 to 15 grammes, Gaz! Med! de Paris, June, 1850; 19, Garrod, general effects, Med. Times and Gaz., 1864, p. 276; 20, Bertholon, general effects. Am. Jour. Med. Sci., N. S., 51, 1866, p. 282 (Cincinnati Lancet and Obs.); 21, Tilbury Fox, Lancet! 1867, p. 455, general effects; 22, Harneau, poisoning of an epileptic female by daily doses for a year of about 16 grammes, Gaz. Hebd., Aquil, 1868; 23, Braman, poisoning of man with asthma by 20 grains, Boston Med. and Surg. Jour., June, 1868; 24, Cholmeley, effects of 15 to 25 grains, three times daily, on a lad aged 13, for epilepsy, Brit. Med. Jour., Dec. 1869; 25, Bazaiue, “Bromism” in general produced in about ten days by 30 to 40-grain doses two or three times a day, Brit. Jour, of Horn., 27, iO; 26, Brit. Med. Jour., Oct. 1869, took 20 grains a day (it soon stopped the “petit mal”), and increased to 70 and 80 grains a day; 27, Clarke, effects of drachm doses at 11 a.m. and 5^ p.m., Brit. Med. Jour., Oct. 1869; 28, Williams, effects in epileptic patients, all more or less insane, Brit. Jour, of Horn., 22, 684 (Med. Times and Gaz.); 29, Hammond, effects of 30 grains three times a day for paralysis agitans, Brit. Med. Jour., Jan. 1870 (Quar. Jour, of Psychol. Med., 1869); 30, Hammond, a man with severe headaches took, of a solution of 1 ounce to 4 ounces of water, a teaspoonful three times a day; headache removed, but following mental symptoms always occurred after the drug; from Hale’s Monograph on Kali brom., 1870; 31, same, a lady, epileptic, took 30 grains three times a day, dose afterwards increased to 40 grains, ibid.; 32, same, similar case, ibid.; 33, same, man with paralysis agitans took 30-grain doses three times a day, ibid.; 34, Van Burn, effects of large doses in woman with epilepsy, ibid.; 35, same, similar case, ibid.; 36, same, similar case, ibid.; 37, same, large doses for paralysis agitans in a man ; 38, same, large doses for epilepsy in a woman ; 39, same, man took 20 grains three times a day for wakefulness ; 40, same, 15-grain doses for epilepsy in a woman; 41, same, effect of 1- drachm doses in epilepsy; 42, same, a man took for wakefulness 20 grains at 11 P.M. and 3 a.m.; 42a, sane, a lady took an ounce in the course of a month; 43, Dr. Tabret, general effects in epilepsy; 44, Lisigue in same; 45, Wood, after several moderate doses effects suddenly appear, Brit. Med. Jour., Oct. 1871; 46, same, effect of increasing doses up to a drachm three times a day in acute mania; 47, same, effect of i to 1 drachm three times a day in general paralysis of insane; 48, Clarke and Emory, general effects. Monograph, Boston, 1874; 49, C. Wesselhoeft, effects of nightly doses of 5 to 20 grains for three days for nervous depression, sleeplessness, etc., N. E. Med. Gaz., 8, p. 514; 50, Neumann, general effects, Wien. Med. Woch., 1873 ; 51, Turnbull, effects of protracted use of drug, from Hale’s Monograph; 52, Ramskill, gastric effects, from Hale; 53, Puche, effects of enormous doses (360 grains) in syphilitic patients. Hale; 54, Voisin, “ De I’Eruptions de Brom. de Pot.,” p. 70, general effects; 55, same, effects in a boy with epilepsy of 1|^ to 5 grammes daily for seven months; 56, same, large doses in an epileptic boy; 57, same, in an epileptic female ; 58, same, similar case; 59, same, similar case; 60, same, general effects; 61, Lubben, a maniacal woman took 2^ grammes three times daily, Allg. Zeit. fur Psychol., 1874; 62, same, effects on an epileptic patient after ten days ; 63, Palm, poisoning of children by crystals, Med. Corresp. Blatt, 1852.

Mind p. 265

Emotional. Delirium

General delirium, with hallucinations ; delusions about persecution and violence

Decidedly insane; had delusions that lewd women had got into his mother’s house ; that he was pursued by the police; that his life was threatened by members of the family; that he had thousands of dollars in gold sewed up in his clothing, etc.; his appearance and manner were very similar to those of a drunken man, except that his face was exceedingly pale; his pulse, which was normally about 80, had fallen to 60; skin cool; pupils contracted; his manner was excited and rambling, and his hands constantly busy, either in fumbling in bis pockets, tying his shoes, picking threads from his clothing, or in searching for the gold which he believed was concealed in the lining of his coat; his character also had undergone a radical change, from having been very frank and brave, he had become excessively timid, and suspicious of every trifling circumstance; it was ascertained that he had secreted large quantities of the Bromide in various out of the way places about the house; several times he attempted to throw himself from a window, and battered down a door with an axe, in order to escape from some imaginary danger; he was removed to a lunatic asylum, where the symptoms gradually disappeared, and in a month he returned to his home well,*®

He imagined that he had been specially singled out for divine vengeance, and he spent the greater part of the evening in loudly deploring his sad fate, falling suddenly asleep at intervals of a few minutes ; towards 12 oclock he became quiet, and passed the rest of the night in a sound sleep (first day); he was walking his room, groaning and wringing his hands; he informed me that he had been accused of robbing a friend, and that the officers were in search of him (second day); slept from about 6 p.m. till 5 A.M., when he was quiet, composed, and altogether in his right mind (third morning)

She had the erroneous idea that she was deserted by all her friends, and as a consequence she passed all her waking moments, which were not many, in tears; another delusion, that her child was dead, had taken fixed possession of her mind ; she declared that she saw it dead before her, and when it was brought to her, she refused to acknowledge that it was hers, or had any resemblance to the one she imagined was dead (eighth day),®h

Very soon she began to manifest symptoms of melancholy, attended with delusions; she was taken to Long Branch, and while there continued to be insane; she fancied that the boarders in the hotel insulted her, and imagined that the weekly bills of the landlord were evidences of a conspiracy wdiich had been got up against her father; on the way up from Long Branch to this city, while standing on the guards of the boat, she suddenly gave a loud shriek, and declared she had seen her brother fall overboard ; the administration of the Bromide was stopped, and in a few days her mind became sane, and has since remained so; throughout the whole progress of this case, there was profound depression of spirits, and all her delusions were of a melancholy character,®k

The mind was more composed, and much less excitable than usual (while taking the drug)

When the drug acts favorably, a sense of buoyancy, comfort, and relief, rather than depression, accompanies its exhibition

Frequently she would burst into tears for no cause whatever (after three days)

Depression of spirits for two months, then gradually disappearing

Depression of mind, during which he experienced the most gloomy ideas relative to his present and future condition, if an opinion could be formed from the signs of distress, such as weeping, moaning, and wringing his hands, which he continued to manifest; two hours after this he fell asleep, and when he awoke eight hours afterwards was perfectly sane (fourth day)

Mental depression

Marked mental depression (after a month)

Great mental depression, a feeling of approaching death

Fearfully depressed, and frequently shed tears

A consciousness that the currents or sources of psychical force are hampered sometimes makes an intellectual patient, who is moderately bromized, reason himself into depression, but spontaneous depression is rare

Very absent-minded, low-spirited, and childish, giving way to her feelings

No inclination to mental excitement or amusement; rather sad and indifferent to things, lasting for five days (sixth day)

Painful sadness, profound indifference, and almost disgust for life (after one to two hours),^h

Profound melancholy, with delusions

Such intense melancholy and weakness that I was obliged to reduce the quantity to 20 grains

The immediate effect was the production of the most intense melancholy, attended with fits of uncontrollable weeping ; these symptoms lasted three or four days, and were then accompanied with periods of positive delusion ; gradually they disappeared, although the doses of medicine were not reduced

Feeling of anxiety, depression, etc.,’®.

The patient, who has been violently excited, glorying in his imaginary power of body and mind, becomes desponding, sullen, melancholic, and frequently lachrymose, often even despairing

At times he cried most bitterly, yet twelve hours previously he was singing and dancing, saying he was the happiest man alive,”^h

Listless, apathetic

Iiltellectllfll. Intellect and will unimpaired and active

Intellect and emotion may seem sluggish, but when roused they act normally

Mind calm, not worried and fretful as usual; have been rather disinclined to use the mind at all (fifth day)

The patient was torpid mentally

Intellect clouded; mind confused; unable to concentrate the thoughts; slowness of perception; questions have to be asked several times before their meaning is understood and an answer can be obtained

Dulness, stupefaction

Dull, depressed, irregular in his gait, in the morning; in the afternoon completely helpless

After awaking, the will power seems lost, and thought and self-consciousness cannot be regained; one feels plunged in dulness and torpor (after one to two hours)

Mental hebetude (after large and continued doses)

Slowness of comprehension

Decided weakness of intellect

Enfeeblin'g of mental power; a little page in my accounts, which I should usually have prepared and balanced in half an hour, took me two or three evenings work ; but the worst tendency was to talk Mrs. Malaprop English, substituting one word ending in “tiou for another in a most provoking and yet ludicrous way; I had once to write some letters reminding people that their subscriptions were due, and I had the misfortune of having my letters (I think one or two of them) brought back to me by the clerk, who pointed out to me that I had written contraction or some such word instead of subscription,”*®. Difficulty of collecting ideas

Inability to express oneself

Remarkable slowness of speech, and difficulty of collecting the ideas and expressing them

In such a confused state that I could not get on with my work (second morning)

Incoherent, full of delusions of no fixed character, and remarkably depressed in spirits (seventh day)

Feel as if everything that I feel, see, or think, had been experienced before, as in a dream; this delusion is so strong that I could swear I dreamt it all (six hours and a half after second dose)

The effect upon the mind was quite marked and decidedly curative, for it improved the memory, and dispelled a distracted, uncontrollable state of mind

The mental and bodily impressions received during the different stages of the medicinal action are very clearly retained in memory

Memory impaired

The memory and thinking faculty were impaired

Sometimes temporary impairment of the memory (aftercontinued doses)

Failure of memory

Loss of memory for two months, then gradually reappearing,®®. *Loss of memory to such an extent that he forgot how to talk; for instance, when asked why he took so large a dose, he was fully two minutes endeavoring to frame a Reply, and was then obliged to give up the attempt with the remark I can’t in fact, Hhere was well-marked amnesic aphasia, for there was no difficulty in co-ordinating the movement of the tongue so as to articulate distinctly any word he was told to pronounce (fourth day)/

Memory was absolutely destroyed ; she could not recollect the simplest things, and even forgot her own name and that of her husband, though reminded of both an instant before (after three days)

On waking in the morning I could not remember anything which had happened to me the night before, and asked my brother what day it was, the month of the year, etc.,^h

What he writes is almost unintelligible, from the omission of words, or parts of words; words are often repeated or misplaced

A hospital patient, who, while subjected to the continued influence of Bromide of potassium, forgot certain syllables or paits of certain words, and when writing or speaking did not write or utter these; thus he called quelques, qques, and sometimes he duplicated one or two syllables of a word

In some individuals the memory is oddly affected ; ^single words are forgotten, or one syllable is constantly dropped out of a word, whenever that word is spoken by the patient, or two words are invariably interchanged; thus, a lady, twentyeighth or thirty years of age, suffering from chronic ovarian disease, to whom I gave about 12 grains three times a day, making a continued daily dose of nearly 40 grains of the Bromide of potassium, began, after she had taken it two or three weeks, to exchange two words for each other; she called a buckwheat cake a comb, and a comb a buckwheat cake; at the hour of her morning toilet she would direct her maid to bring her a buckwheat cake and arrange her hair; at breakfast, if there were buckwheat cakes on the table, she asked for a comb to eat; once during the existence of this peculiarity, I undertook to convince her that she had transposed these words, and that a comb was a spoken sign of a comb and not of a cake; the effort was unsuccessful; she never transposed or confused the ideas of cake and comb, only the words or signs

Weakness of mind, a kind of stupor, especially in well-educated and actively engaged persons (after long use)

Hebetude, with inability to think; a kind of stupor, resembling that of the first stage of typhoid fever

Stupor

Moderately deep coma,®k

Heath, (Joitfttsiofi VevtiffO. Confusion and heat of the head,®^ Vertigo

Vertigo, fainting, and nausea, followed by sound sleep

Great vertigo with confusion of the head (after a few hours)

On attempting to stand up, and especially to walk, there is a peculiar vertigo, characterized by a sensation of emptiness around one, and under one’s feet, so that one is afraid to move; it seems as if the ground gave way, and the sense of resistance was lost; the gait is staggering, and at last walking becomes almost impossible, or, at least, one feels obliged to give it up (after one and two hours),A Dizziness

Inability to stand erect on account of excessive dizziness

The giddiness was generally accompanied with drowsiness and sometimes with actual stupor

After the chief symptoms have disappeared, there remains a peculiar heaviness of the head, not amounting to actual headache,V

General Head. Headache; (after a few days),®®, etc.

Dull headache; (after large doses)

Headache, with heaviness, and pressure on forehead and temples

A remarkable _ headache; soon after setting in it developed a sort of dulness and giddiness, such as may be observed in some forms of typhus

Forehead. Pain in forehead and occiput (after one hour)

Headache in the right frontal protuberance, after a simple dinner; it increases at 9 p.m. (sixth day),«

Eyes p. 269

Objective. Expressionless gaze; lustreless eyes

Hollow, fixed eyes

Eye lost its lustre (after a few days)

Dull-looking eyes

Bloodvessels on the fundus of the eye were enlarged

The results of the smaller doses were not altogether uniform ; a certain degree of congestion appeared, however, to be produced. With half drachm and drachm doses, and once with a scruple dose, the disk and retina were congested even in ten minutes after administration, and this state of congestion went on increasing, as long as examinations were made; even after the lapse of several hours, the increased redness was still manifest; the vascularity was found to be greater as the dose was increased. The exceptional phenomena were, in one case, a brighter redness of the vessels after ten grains. In another case, a hazy condition of the vessels was noted, after a scruple dose

Lids, Drooping of the eyelids

Constant closing of the eyes, more noticed when sitting up than when lying down,®l

Ptosis, gradually becoming complete, so that the lids hang far over the eyeballs

Conjunctiva. Conjunctiva often congested

Sensibility of conjunctiva so deadened, that a finger may be passed with impunity on the surface of the eyeball, without producing winking

Eupil. Dilatation of the pupils

Dilated and uncontractile pupils

Pupils dilated, and contract very sluggishly under the influence of a strong light

Pupils contracted; (fourth day)

Contraction of the pupils

Pupils contracted (fourth day)

Pupils strongly contracted; (second day)

Pupils greatly contracted (after three days)

Vision. Sight became disturbed

Eyesight weakened (after three days)

Momentary weakness of sight and hearing

Very weak sight

Dimness of sight, with dilated pupils

Sight becomes dim, and the lids so heavy that they can hardly be kept open; there is a general feeling of torpor, and an invincible drowsiness (after one and two hours)

The eyes do not see (after toxic doses)

Hallucinations of sight and sound, with or without mania, precede cerebral indifference, apathy, and paralysis (after toxic doses)

Head p. 269

Hearing became disturbed

Hearing weakened (after three days)

Hardness of hearing

Hearing loses its usual acuteness, and it is only by speaking in a very loud voice that the patient can be roused from his stupor

The ears do not hear (after toxic doses)

At night in bed, had roaring in the ears, synchronous with the pulse

JVose. [HO-] Nostrils full of thick mucus and yellow scabs

The salt found in the nasal mucus (after half an hour)

Smell weakened (after three days)

Face p. 269

Languid expression

Wearied, anxious look (after a few days)

Looked queer (first evening), and as if frightened (second morning)

Dull, stupefied expression

General aspect of hebetude and indifference (after toxic doses)

The expression of hebetude becomes first that of imbecility, and then that of idiocy (after toxic doses)

Yellow, cachectic complexion

Dirty yellow complexion

Face pale (second day)

Face pale, suffering

Face exceedingly pale

Face ashy pale (fourth day)

Face thin

Mouth p. 269

Gums. Painful gums, sometimes red and swollen

Tonyue. Tongue red, dry, and enlarged (in a few hours)

Tongue moist and red at first, but after a few days it has a tendency to drying and browning

Coated tongue (second day)

Foul breath and a white tongue, involving the edges as well as the dorsum, and not necessarily furred, with great languor and sleepiness

Tongue presented every appearance of the effects of a corrosive poison

Disordered action of the tongue; difficult speech

General ISIoutll. Fetor in the mouth

Dryness of the mouth

Long-lasting dryness of the mouth (after the increase of saliva) occasioning a desire to drink, sometimes very urgent (after a few minutes)

Irritation of the mucous membrane of the mouth and fauces; the tongue was painful and the papillae very prominent, with redness and burning through the whole of the mouth and fauces as after some acrid substance

Saliva, Increased secretion of saliva

Increased secretion of saliva, with frequent spitting (after a few minutes)

r Transient increase of saliva and mucus in the mouth

Slight increase of the salivary secretion (immediately)

Profuse secretion of tenacious saliva, with fetor from the mouth

Salivation

Salivation and salt taste in the mouth

Salivation, not copious, but merely disagreeable

Ropy mucus on the tongue, lips, and inside the mouth

The buccal mucus becomes sticky

The salt found in the saliva (after half an hour)

Taste. Very foul taste in mouth (after a few minutes)

Slightly salt taste (immediately)

Taste weakened (after three days)

The tongue does not taste

Speech, After awaking, speech is difficult, slow, and not seconded as usual by the operations of the intellect (after one and two hours)

Hesitating speech

Occasional stammering (after continued doses)

Unable to speak

Throat p. 270

Some patients experience a peculiar sensation of dryness of the throat and neighboring parts

Irritation in the mucous membrane of the throat and stomach (after 3 to 4 grammes, 60 grains daily)

Tickling in the throat, a short time after every dose

Uvula, (Edema supervenes on congestion of the uvula and fauces (after a toxic dose)

Insensibility in the region of the velum palate and pharynx

Ausesthesia of the velum palate, the uvula and upper portion of the pharynx, so that these parts may be tickled without producing nausea, or involuntary movements of deglutition ; swallowing itself, however, is unimpaired

Fauces Pharynx and CEsopJiagas. Mucous membrane of fauces highly injected

Anaesthesia of the fauces seems the last symptom to disappear

Anaesthetic effect on the mucous membrane of the fauces and upper respiratory organs, by which their reflex action becomes diminished

Moderate anaesthesia of the pharynx

According to Voisin, the local anaesthesia of the pharynx does not appear after a less dose than 30 grains ; it is not always produced by this dose ; but if two or three such doses are given several hours apart, there will be impaired sensibility of the pharynx for several hours after the last dose; consequently, a continued daily dose of above half a drachm generally affects the sensibility of the pharynx in proportion to the amount taken above that quantity; but only one part or kind of the sensibility of the pharyngeal mucous membrane is impaired or abolished We should distinguish says a late writer,! “ two kinds of sensibility in the region of the veil of the palate, a functional sensibility and an ordinary sensibility; the ordinary sensibility varies with different individuals ; but it is not the measure of the functional sensibility ; the latter varies but little ; this functional sensibility is the same as the sensibility of the intestine; and like the latter, it depends, according to M. Claude Bernard, upon a ganglion, the spheno-palatine ; it has its special mode of irritation, which is neither pricking nor burning, but the lightest contact; if the touching even [chatouillement'] exceeds the physiological limit, vomiting is produced ; bromide causes this to disappear at once; movements of deglutition remain intact in bromized individuals, and are not performed with less energy than previous to the treatment; when, by titillation of the uvula, no effort of deglutition or vomiting is induced, it is apparent either that the pharynx and palate no longer conduct the tactile impression, or that this impression is not reflected; as the reflex power of the cord has lost none of its energy, and there is no want of precision of movement, we must admit that the periphery alone is affected

Irritation of the fauces generally, with oedema and redness, and sometimes with paleness of the parts (after continued doses)

Constant dryness of the oesophagus,^l

Swalloiviitf/. Difficult deglutition

Unable to swallow

External Throat, (A very perceptible enlargement of the thyroid gland disappeared), (while the drug was taken or immediately afterwards)

Stomach p. 271

Ajipetite. Increased appetite

Appetite somewhat increased

Appetite remains very good, patient takes his food very well, and dozes off immediately after

Less appetite for breakfast, no appetite for dinner (fifth day)

Loss of appetite

Anorexia; (second day)

Thirst. Thirst

Much thirst all day, but able to drink only a mouthful, as the cool water is unpleasant (fifth day),*®. Great thirst

Intense thirst, and a craving for cold drinks

Eructation. Eructations

Repeated eructations; (after a few minutes)

Eructations without nausea (immediately)

Nauseous eructations, and inclination to vomit

JSfaiisea and Vomiting. Nausea; (after one hour)

Nausea and vomiting ®®.

Sometimes slight nausea directly after a dose, which soon disappears

The nausea and pain in stomach were most frequent when lying on left side

Sickness (soon); (after a few days)

Sick and giddy

Repeated retchings and emesis

Vomiting

Repeated serous vomiting, for nearly seven hours

Vomiting of frothy mucus

Stomach. The stomach was weak for a long time afterwards

Some degree of gastric anxiety (after one hour)

Habitual gastralgia

Much agony in region of stomach

Sensation of fulness and heat in epigastric region (after a few minutes)

When taken fasting, a little pinching or constriction of the stomach (immediately)

Peculiar pressure in the epigastric region, followed at times by violent colic

Distressing oppression of the stomach after dinner

Abdomen p. 271

Enibilical. Violent periodical pains in umbilical region, which is very sensitive to touch, ■without being distended (second day)

Colic-like pains in umbilical region (even after six or seven , weeks)

General Abdomen. Rumbling

Much flatulence (while taking the medicine)

Emission of flatulence

Frequent emission of flatulence

Emission of much flatulence

Feeling of warmth in the abdomen

Violent pain in the abdomen

Pain following the course of the ascending colon

Colic

Sudden colic disturbing the rest at night

Attacked with flatulent colic in the region of the duodenum, at 4.30 A.M. (one hour after second dose), which passed off in a watery diarrhoea during the day

Rectum and Anus p. 271

Tenesmus, once

Stool p. 271

EiarrJloea. Increased evacuation of the bowels

Diarrhoea

Diarrhoea (in a few rare instances after continued doses)

Diarrhoea; on using cloths they were found to be stained of a violet color

Purging

Purgation, with abdominal pain of a dull aching character

Hypercatharsis, repeated again and again each time the medicine was taken (in two cases)

Cases have been recorded where the hypercatharsis was so marked that the drug was discontinued; out of 37 cases treated for epilepsy by this drug 2 patients had to discontinue its use on this account/®.

Soft stools/.

Stools softer than usual/

Stools softer and more frequent/.

Constipcitiofl. Constipation/ ®.

Slight constipation (after continued doses)/®.

Bowels sluggish in their action, but not very confined

Fjeces diminished in weight and usually procrastinated

Dryness of the excreta of the intestinal canal follows its continued use, and the stools become dry, hard, and infrequent,"*®.]]

Urinary Organs p. 272

Bladder. Feeling of vesical distension and irresistible desire to urinate (during the partial slumber)

31micturition. Disposition to urinate/®.

Bowels were regular, with frequent desire to pass water, but which was, however, rather diminished in quantity (while taking the drug)

Frequent emission of thin yellowish urine

Emission of a large quantity of clear yellowish urine

Frequent and profuse emission of urine

Discharge of urine both frequent and more copious (eleventh day), also in the preceding night; in the evening of the eleventh day about half a pint of urine passed every half hour for several hours; the urine was pale, of high specific gravity, loaded with what appeared to be phosphates, of which a cloud was passed with the urine ; the minute crystals could be plainly seen when held up to the light in a beakerglass ; on standing for a few minutes the sediment filled one-quarter of the space occupied by the liquid ; heating the urine precipitated the phosphates in a white cloudy sediment; addition of nitric acid immediately dissolved it

The quantity of urine passed in the twenty-four hours was increased. This was not due to the increased drinking of water

Scanty micturition

Urine. Increase of renal secretion (after continued doses)

Increased secretion of urine ®.

Increased secretion of thin urine

A moderate increase of the urinary secretion, during the morning or day after taking

Copious secretion of urine

Copious secretion of thin and clear urine

Increased urine

Increased amount of urine

Profuse, thin, pale urine, peculiarly offensive

68 ounces of urine were secreted in twenty-four hours, although on the same day a Turkish bath was taken, and a considerable portion of the drug was doubtless eliminated by the sweat. The average daily amount of urine excreted by the same individual, as determined from observations on seven successive days, was 44 ounces

Diminished secretion of urine

Urine paler and thinner than usual

A trace of the drug was discovered in the urine (after ten minutes); a considerable quantity found (after ten to twenty minutes)

The acidity of the urine was usually increased; the coloring matters were invariably increased; the urea was not affected; the phosphoric acid varied; by small doses it was increased; the chlorides always and notably increased, save when the bromide was acting as a poison ; this chloride leaving the body was chloride of potassium ; the figures of the three experiments were an average of 22.56 grammes of chloride of silver in twenty-four hours on the days preceding the exhibition of bromine, and 24.29 on those days when that salt was taken. Analysis showed in some of these cases the amount of potash in the urine increased from (estimated as chloride) 2.5 to 12.80 grammes

Uric acid especially increased

Sexual Organs p. 272

More or less debility of the genital organs

Decline of sexual power (after long-continued use)/l

Sexual weakness degenerates into impotence (after a toxic (lose)/

It exerts a most powerful influence on the generative organs, lowering their functions in a remarkable degree

During the partial slumber, especially if in bed, thei’e quickly arises a greater or less degree of sexual excitement (according to previous habit), usually accompanied by erections and emissions, which awake the subject, and of which he is perfectly conscious

Repression of sexual desire and power does not usually occur until the salt has been taken for several days continuously ; its extent is exceedingly variable ; in some individuals it merely amounts to a moderate diminution of desire; in others there is a temporary impairment of power

Diminishes and ultimately entirely neutralizes the sexual appetite,™.

From the beginning the sexual appetite fails; erections are rare and imperfect, and cease altogether after a tew days,™.

Pain, swelling, and tenderness of the left testicle and cord (second day),'l

Respiratory Organs p. 273

Laryngo-bronchial weakness, sometimes with cough, and sometimes with a changed or whispering voice, rarely with aphonia (after continued doses)

It appears to produce an an8esthetic condition of the larynx and pharynx

Voice. Painful, exceedingly disagreeable hoarseness for a long time, most violent after he had taken 37 grains in nine days

Faint voice

The whispering voice sinks into aphonia (after toxic doses)

Hacking cough

Dry, fatiguing cough

Paroxysmal dry cough at intervals of two or three hours, with difficult respiration, followed by a vomiting of mucus or food; worse at night or when lying down, and bearing much resemblance to whoopingcough

Respiration. The carbonic acid of the lungs was decidedly decreased. The decrease in carbonic acid was followed, on the days succeeding the use of the bromide, by increase above the normal quantity

Vascular bruit de souffle

Breath has a disagreeable odor, which seems peculiar to those who have been for any length of time under the influence of the drug

Fetid or bromized breath (after continued doses)

The fetid breath becomes nauseous (after a toxic dose)

Respiration, without the stertor of opium or alcohol, is easy but slow (after toxic doses)

Respiration calm and tranquil, with occasional sighing,™.

Anxious respiration,™.

Difficult breathing

Chest p. 273

Symptoms of pulmonary catarrh

Tightness of the chest, on breathing

Oppression of the chest

Heart and Pulse p. 273

Heart’s Action. Reduces the action of the heart and arteries,™.

Heart’s beats lacking in energy, and its sounds distant and feeble (in its effects on the heart the drug seems to resemble Digitalis),™.

Heart’s action feeble and intermitting

The heart’s action gradually grows feebler till it ceases altogether

Heart’s action very feeble

Action of heart slow and fluttering (after a few days),™.

Heart’s action slower and feebler (after toxic doses)

Valse, Accelerated pulse, after awhile it was at times several beats slower than natural,k

Pulse irritable and rapid

Pulse small and very frequent,™.

Pulse slower, except during actual vomiting

Small and slow pulse

Pulse weak and slow, ™.

Pulse notably slower as well as depressed

Pulse, which normally was about 80, had fallen to 60,®®.

Pulse much lowered (40 to 48)

Pulse very low, after the fever

Back p. 273

Pain in loins

Pain in the region of the kidneys

Pa n, seemingly seated in the region of the kidneys

Extremities in General p. 273

Disordered action of the extremities

A sort of muscular weariness and a bruised feeling in the limbs and loins (after waking

Superior Extremities p. 274

Trembling of the hands during voluntary motion

When he raises his hands, as in the act of carrying something to his mouth, they tremble as if he ht\d delirium tremens,^“. Handwriting shaky and indistinct

Hands and fingers in constant action (second day)

Almost constant twitching of the fingers, and a busy occupation of them in matters of no importance (after three days)

Inferior Extremities p. 274

Gait unsteady (second day)

.Unsteadiness of gait, so great that he was frequently taken for a drunken man, and on one occasion was arrested by the olice, confined in a cell all night and fined the next morning, notwithstanding my statement of the facts to the police superintendent

Great unsteadiness of gait for two months, then gradually disappearing

Irregular in his gait,*k

Irregular gait, the patient reeling as though intoxicated

Impaired locomotion, which, when the dose is excessive, resembles the gait of locomotor ataxia

Reeling gait and general appearance of intoxication

On beginning to walk, the first steps are undecided and staggering, but the gait soon recovers firmness (after waking)

Staggering

Staggering gait; walking is quite difficult

Could not walk without staggering very much

By degrees his gait becomes altered; he rolls and staggers like a drunken man ; his limbs shake and bend under him

Unable to walk (seventh day)

Could scarcely stand, and that only with support

Unable to stand (fourth day)

Weakness in the lower extremities, and inability to stand ■erect (after three days)

Unusual weakness at the knees (after a few days)

Weakness of the extensors of the legs and feet

Generalities p. 274

Objective. An increase of destructive, without a corresponding increase of constructive metamorphosis, and consequent emaciation (after continued doses)

Diminishes the retrograde metamorphosis of tissue

Diminution of mucous secretions generally

The capillary circulation is materially affected, not only of the nervous ■centres, but of the whole system; this, however, is independent of the heart and large arteries

Emaciation (after long-continued use)

General emaciation

Considerable emaciation

Great emaciation

Very emaciated and weak, and of a peculiar pallid color

Marasmus and emaciation, which endanger the life, may set in alter too longcontinued use

Among the symptoms caused by the drug there are some which have escaped the notice of previous observers, but which, if not recognized, might lead to serious mistakes in diagnosis. I refer to cerebrospinal affections

characterized by general delirium, hallucinations, fancies about being persecuted, violent actions, ataxia of the limbs and of the tongue, and impeded articulation

which might be taken as indications of general paralysis. All these alarming symptoms disappear on leaving off the medicine

Better than usual, less tired, with more ability and inclination to walk than previously (while taking the drug)

Sedation

Averse to exercise; sits and lounges about

Invariably sat crouched up by the fireside all day, evidently devoid of all energy and resolution

Disinclined to talk, read, or study, to walk or work; quite indifferent to many objective annoyances that commonly irritated him ; in fact, superlatively lazy, indifferent, and sleepy, yet by a strong effort of will able to converse, study, compose, walk, work, and fret as well as ever

Languor of movements

Great languor

Unusually quiet, sitting languidly on a chair.; he could not collect his thoughts to answer a question properl}^^®.

Lassitude (soon)/®.

Weakness/.

Weakness of the muscular system,-®.

So extreme a degree of weakness that the medicine had to be stopped/®.

Great feebleness, physical and mental, after disappearance of the symptoms/®.

General debility/

Great muscular debility

Considerable prostration, compelling him to lie down (after one hour)

Great bodily prostration

Extreme general prostration

Inability to walk or stand

Inability to hold herself upright

Unable to move or feel

After a time he is obliged to keep his bed

Extremely adynamic condition

Lies quietly, unable to move, feel, swallow, or speak (after a toxic dose)

There is a class of phenomena dependent on the bromine

cachexia, which must be accurately distinguished

viz., those due to the adynamic character liable to be assumed by acute maladies which may attack an epileptic patient during the administration of the drug. Thus, a pneumonia, an enteritis, a rheumatic seizure, or a simple boil may be accompanied by such a debility of the vital powers as shall rapidly determine a fatal issue

Fainting

Muscular weakness becomes complete paralysis (after a toxic dose)

Remarkable degree of restlessness and fitfulness of motion, as a consequence of the giddiness or intoxication, the patients being sometimes unable to keep themselves on their feet

St(b- Jective. Diminished nervous sensibility in general, and especially diminution of reflex sensibility

Mental and physical lassitude, indisposition to effort, and indifference to all slight causes of nervous irritation ; the crying of children in the house, the rattling of carriages on the pavement, the irritation of worrying or anxious thoughts, all are disregarded ; the sweet carelessness of doing nothing, the Neapolitan’s dolce far nitrite is almost realized; this state is soon succeeded by drowsiness, and drowsiness by sleep (after 20 or 30 grains)

Well-marked numbness throughout the body, and very decided diminution of sensibility (after three days)

Great blunting of the senses; the patient shows consciousness only when loudly called to

Sensibility of skin diminished, so that pinching and pricking are scarcely noticed

Tactile sensibility, the sense of temperature and of tickling appear to be imperfectly conducted, but really unimpaired

The sensibility is so far gone that the skin can be pricked, pinched, and burned even without the patient being at all conscious of it; this insensibility,, however, only’^sets in after the continued exhibition of enormous doses

During the whole period of the action, and even during its decline, there is experienced a profound dulness of tactile sensibility in all its forms, but especially in those which are concerned in reflex manifestations. Thus, tickling of the feet is scarcely felt, and no longer produces its usual effects; cutaneous sensibility}^ when tested by pinching, is found to be diminished ; the perception of touch by the hand is so modified that prehensile movements are deprived of precision

Reflex, general, and special sensations disappear

General feeling of comfort and tranquillity, predisposing to sleep

Sense of mental and physical languor or weakness (after continued doses)

Skill p. 275

Surface in general, and esj>equally the skin of the face, of a dead-white color

Considerable discoloration of the skin and raucous membranes

I. A partial eruption, resembling both acne simplex and indurata; preceded by considerable itching ; appearing chiefly on the chest and face, esi)cially on the shoulders, forehead, and nose. It consists of bluish-red pustules, scarcely as large as a pin’s head, with a red areola, and soon becoming yellowish-white at the tips. Their bases are quite hard, and continue so for several days, sometimes for a mouth, when they suppurate, leaving a firm nucleus and deep-red flush, with a slight swelling, which are of long continuance. The number of pustules is extremely variable, increasing chiefly with the dose. Certain conditions ot the skin, as when it is thick and plentifully moistened by an oily secretion, seem to promote the spread of this eruption, and lymphatic and sanguine constitutions are especially liable to it. It is also more abundant in youth and adult age. At these periods it sometimes even covers the whole lace, to its great disfigurement. The duration ot the pustules is also very variable, eight days, more or less ; depending uniformly on the continuance ot large doses; thus, when an extensive acne eruption has arisen from doses ot 5 grammes or over, the number of pustules will be sensibly lessened it the dose be reduced to 3 grammes. II. The second species of Bromine eruption bears no resemblance to any other affection of the skin. It is confined almost wholly to the lower extremities, where it appears in the form of oblong or circular patches, several centimetres in diameter, with mainillated edges, and generally rose-colored or_ cherry-red, but spotted yellow, as if from subcutaneous purulent infiltration. Its favorite situation is the calf of the leg, as is shown even in cases of repeated relapse. In two patients who were each attacked three or four times, the eruption always appeared in this locality. The central portion, as well as the borders of the patches is sometimes mamillated, the projections, in this case, being formed by acne-like pustules, so closely aggregated as to amount to a swelling; they rise to a height of 3 or 4 millimetres, and then bases are indurated ; the projections, in a few days, partially collapse, their tips discharging a sero-purulent fluid. Phe centre of each pustule then presents an umbflicated depression, exuding a creamy moisture, which dries with thick yellow scabs. These projections are extremely sensitive to contact, and sometimes render walking impossible. It is worthy of note, that then depressed, central portion, on the contrary, is quite insensible and devoid of pain. They are surrounded by a reddish areola, with some tumefaction. They collapse on the escape of their contents, but this process is extremely slow', and the discharge, which may continue for a year, easily oives rise to thick and tenacious scabs. The eruption is sometimes exceedingly obstinate, being kept up by the successive appearance of fresh clusters of pustules, with the resulting maraillations. I have seen two cases in which the swellings on the legs changed into atonic ulcers, resembling rupia, and having foul-smelling, reddened bases, covered with vegetation. Pressure on these ulcers caused a pain like that felt in cuts on the fingers. They afterwards became covered with thick, dirty-yellow, offensively smelling scabs. In one case, the ulcers lasted three months, and in the other seven months. I have never noticed any sympathetic swelling of the glands, or fever. When these eruptive swellings, and this ulceration are cured, they leave behind them indelible traces in the shape of yellow spots covered with scabs; at first, nuclei can be felt in the subcutaneous cellular tissue, and in the vicinity of these the patients are troubled with itching, and even pain and cramps. Generally, the eruption disappears in not over four to six days after stopping the remedy. Only a few days are usually required for the complete development of the tumefactions. Their duration varies, of course, with the size of the dose, but it would appear, from what I have observed in patients, that it is longer in the case of those con-

stitutionally subject to cutaneous diseases, especially herpes. One patient

belonging to this class, continued to be troubled with several of these

swellings on his legs after the dose had been brought down to 2 grammes. I have observed that the eruption is of more frequent occurrence in winter. III. The third species of Bromine eruption is that which is least frequently observed. I have seen only three cases. It consists of slightly elevated, flat, smooth, red patches, of different shapes, long or oblong, with regular or uneven borders ; from 4 millimetres to 2 centimetres in diameter, and varying equally in length; in one case, they measured 6 centimetres. They are of the color called onion-peel in the centre, cherry-red at the circumference, and these colors extend over a considerable space. They are very slightly raised, like patches of urticaria. Their bases are firm but elastic, as in erythema nodosum, which this eruption very closely resembles in the shape of the patches, their hardened bases, and their partial reappearance when rubbed. Their redness momentarily vanishes on pressure. They become white by contracting the underlying muscles, or compressing the adjacent parts. They itch at night, in bed, and in a high temperature ; and are nearly or quite painless when pressed upon. Their appearance is preceded by itching and pains in the limbs, with a sort of stiffness. These preliminary symptoms have been, in some cases, so severe as to confine the patient to his bed for four days before the eruption became visible. In one case, motion of any limb was very painful. The patches appear on the extremities and trunk, avoiding the face, and number from four or five, to twelve or fifteen, on each limb. They vanish as suddenly as they came, but always leave behind them the subcutaneous induration. In one case, the lower halves of both inferior extremities were affected, for four days, with a well-marked oedematous swelling. In a single instance, I observed an unmistakable febrile reaction, as shown by a bodily temperature of 38.2° (Cent.), dry skin and accelerated pulse (92 to 104). This lasted five days, and was succeeded by a profuse perspiration. In two cases only there was coated tongue and loss of appetite. I have never known this eruption to appear except in winter. Its duration was twelve days when accompanied with fever, and in other eases six months; declining, during the latter period, from its first intensity, but never entirely going off until the advent of the warm season. For days or even weeks, after the disappearance of the eruption, and of all redness, elastic indurations, slightly painful on pressure, could be felt in the corresponding portions of the subcutaneous tissue. A yellowish discoloration, resembling ecchymosis, was visible in one case, on the former seat of one of the patches. The appearance of this eruption was always coincident with the prolonged exhibition of the remedy in quite large doses. IV. Several of my patients were attacked with a moist eczema of the legs, and very extensive pityriasis of the scalp. This kind of eczema is only cured by giving the medicine at longer intervals, or stopping it altogether

Affections of the skin seem to be especially seated in the sebaceous follicles and glands and in the sudoriferous glands, causing inflammation with an increase of the cellular elements; in one case the exanthema assumed a furuncular character, especially seated on the hairy portions of the face, on the forehead and neck ; in another case, in a child of eighteen months, the eruption affected the forehead and extremities. and consisted of scattered pimples, partly of a dull whitish, and partly of a pale reddish color, from the size of rnilletseeds to that of peas, which on being opened exuded pus mixed with smegma; on the left lower leg there was also a swelling of the size of a half dollar, covered by a tense mottled epidermis, surrounded by a red infiltrated margin, which on being opened exuded smegma and pus; on the cheeks there were spots as large as a ten-cent piece covered with black crusts, which being removed showed a pale red papillary swelling, which bled easily when touched, and seemed to be formed by the stoppage of the sebaceous follicles and distended by masses of sraegina

Acuminated itching, burning spots, in the skin, especially in the shoulder and in the region ot the neck, showing some similarity to acne

Some scattered acne pimples with yellow tips

Acne

(Dr. C. had seen an obstinate long-continued acne disappear entirely while the drug was being taken for a nervous affection) Acne on the forehead

An eruption appeared on the face and legs, which quickly became copious and very painful; it was like varicella, but the vesicles instead of drying up, became in many places confluent, and the clusters thus formed showed a tendency to enlarge,.and exhibited numerous points of suppuration (after six days)a baud of eruption up each side of the lice and across the forehead,, while the front and outer side of each leg were covered with it from knee to ankle. On the face it consisted of irregularly circular, elevated, flattened, light-brown crusts, varying in size from a pea to a fourpenny piece, surrounded by slightly red areolae, and so adherent that they could not be removed without causing bleeding. On the legs, the skin between and around the spots was vividly red, exquisitely tender, hot and painful, the pain being of a burning, tingling character. Movement of the legs caused very severe pain ; the smallest spots, which were also the most recent, consisted of circular elevated conical vesicles, filled with a milky-white semifluid matter,and seated on a slightly elevated hardened base; the largest spots were from one to two inches long, irregularly oval or oblong, elevated, flattened on the surface, and covered with flaccid moist cuticle, or light-brown crusts, under which the surface presented “numerous milletseed-like yellowish-red prominences [Dr. C. was convinced that it was a severe and confluent acne excited by the medicine.] The eruption began by a minute red, hot and tender pimple, on the summit of which there very quickly formed a small yellowish-white tense conical vesicle pierced by a hair; if the vesicle were ruptured and gentle pressure applied, a smooth yellowish-white substance was obtained, which proved to be sebaceous matter with the bulbous root of the hair; if the vesicle were let alone, it rapidly enlarged, and then was found to contain pus. The crusts of the older spots were partially dissolved by ether, which, on drying, left a greasy stain, while the remaining portion of the crust was found to consist of epithelium and damaged blood-cells and pus-corpuscles. When the eruption had, after seven weeks, nearly died away, the medicine was again given in full doses; and on the sixth day, the eruption began to come out very actively, most on the legs, movement being again very painful,''^f

Acne does not always appear after taking the drug ; I should say that two-thirds of the persons to whom I have given it continuously suffered from acne; I do not recollect ever to have seen it follow a single dose; the number and continuance of the eruption are variable; in some individuals it is sparse and each pustule is small; in others it is abundant, and many of the pustules are large; it affects the face, scalp, and back, rather than other parts of the cutaneous surface; the pustules appear in successive, but irregular, crops; they vary in size from a milletseed to a large pea; generally they disappear without suppuration, each individual pustule lasting only a few days; in some cases, suppuration occurs; when this takes place, each pustule lives longer than it otherwise would, and as new pustules are constantly cropping out, the eruption may become unpleasantly copious; a moderate degree of heat with some itching usually attends the eruption, but this is not invariable ; no permanent scar or mark remains after the disappearance of the pustules, though a red spot points out where they have been for some time after their departure

Numerous acne-like eruptions on the cheeks and forehead (after one mouth),®k

Erythema and swelling of the nose; at least in one case this appeared to be its constant action; and in the experience of those who have given the drug largely, an ecthymatous eruption

Patches and pimples on both forearms,“k

Eruption of red patches on the legs; pains in and around them ; they are mostly about 1 centimetre in breadth, some about the calf are as large as 4 centimetres; the redness disappears on pressure, but returns immediately; the lightest pressure is painful They are but little elevated, and impart to the finger a feeling of a hardness going deep down into the derma (as in erythema nodosum). There are ten of these patches on both legs; all movements of the legs are very painful

Eruption on the limbs resembling erythema nodosum, itching, especially at night; it consists of red patches, about 1 centimetre in length and breadth, slightly raised on an indurated base; the redness disappears under pressure; no pain on pressure. The eruption extends all over excepting the face; in some places it has disappeared without leaving any marks, or any cutaneous induration. The patches are of different sizes, irregular in shape, cherry-red on their circumference, onion-peel colored in their centre ; they look like urticaria. They turn white on exerting the affected limb, or pressing on the surrounding parts. Pressure causes the momentary disappearance of the redness. Itching of the red places, in the evening, when going to bed, in the night, and in general on getting warm ; they sometimes disappear and return spontaneously; there are at least thirty of them on the arms

On each leg, above a dirty-yellow scab of older date, is a red patch formed by an aggregation of acne-like pustules, some of which exude a creamy fluid, like that discharged from boils. Between the pustules appear yellowish-white spots, the size of milletseeds, and somewhat elevated ; where there is no discharge, the surface is cherry-red and has a doughy feel; the skin around the eruption is light red. The patch rises to the height of from 0.003 m. to 0.004 m., is almost circular, and measures 0.025 m. in height, and 0.02 m. in breadth. Upon the right cheek is a very similar eruption, but not so far advanced ; it is formed of vesicles and yellowish white pustules grouped in an exact circle around a cherry-red place where the skin is somewhat raised and flabby, as in essera ; this patch is surrounded by a deep erythematous flush to a maximum breadth of 0.003 mm. The base of the patch is quite indurated ; it is notably painful ; its diameter is 0.015 m. and its height 0.002 m. to 0.003 m.,®l

A papular eruption surrounded her forehead, and spread over the scalp

Eruption on the calves of very painful red pimples and tumors, with smooth, raised, shining edges; a central depression covered with a scab, and having a red periphery and a very hard and sensitive base

On each leg are two places covered with thick, dirty-looking, offensively-smelling scabs; these, when removed by poulticing, leave an uneven surface, formed by a kind of vegetation, and looking somewhat like the stomach of an ox. The patches are of a reddish color, and cause some pain, like that of a cut

Sleep and Dreams p. 279

Sleejnnesfi. Great sleepiness,^l

When given in large medicinal doses, sleepiness or drowsiness and dull headache were occasionally noticed,R

Great sleepiness; drop asleep soundly in a chair during daytime ; if waked up, fall right asleep again, lasting for five days (sixth day)

Sleepiness, even to coma (after large and continued closet!)/

Inclined to doze, and often dropped off to sleep

Drowsiness

Drowsiness, somnolence, and constant dropping off to sleep, Extreme drowsiness; she slept all night, and would often fall asleep in her chair, and in most uncomfortable positions (after third day),^h

Somnolence

More or less somnolence (after continued doses),Constant somnolence

The continued dose keeps up a sort of semi-somnolent state, whereby the system is predisposed to sleep, and slumber at night rendered more profound

The sleep is like a state of heavy somnolence; it is often broken by a start; yet there is no actual dreaming, rather a sort of vague nightmare; the slumber, however, is prolonged indefinitely, and waking is very difficult

Sleep,™.

Deep sleep

Sound sleep, lasting eight hours

Quiet and profound sleep (after 40 or 50 grains at night, when simply wakeful in consequence of mental labor during the evening, but not exhausted)

More profound slumber than usual (after 30 grs., when neither tired nor wakeful)

“The hypnotic action says Voisiu,t referring to his patients in the Bistre was very remarkable upon them, both by day and night; some wer obliged to sleep for a few minutes at a time in the midst of their work ; none, in spite of whatever efforts they made to the contrary, could resist sleep directly after their evening meal; during the night their sleep was calm, and in the morning it was difficult to rouse them

Decided hypnotic action upon an adult in a physiological or normal condition, whether given by day or night (after 30 to 60 grains)

Slept well after smoking in the evening, which is never the case at other times, as it causes starting and nightmare

Slept better at night while taking the Bromide, but woke up frequently; during sleep there were many confused dreams

Profound and disturbed sleep, from which I woke with a mental struggle and effort, not knowing at first where I was, or what had become of me; in fact, I seemed to have gone far down into the gulf of sleep,™.

Sleeplessness, Wakefulness, not sleep, was the result; but if sleep did not follow the dose the general quietude and nervous sedation before described did (after 40 or 50 grains at night, after a day of hard and exhausting work)

If the brain is already in an anaemic condition, it is not wise to deprive it still further of blood, by giving the drug; if this is done, sleep may sometimes follow, but more commonly the result will be the opposite

Only a half-sleep occurs

Insomnia,™. 'pains. Frequent dreams at night

The slumber is more or less disturbed by dreams, which were sometimes very heavy and difficult to shake off

During sleep there were many confused dreams

Restless for four or five nights, being frequently awakened by voluptuous dreams, with severe erections

Fever p. 280

Chilliness. Lowers the temperature

Skin cool,™

Skin cold and clammy (after a few days)

Chilliness

Shivering (after a few days)

Extremities cold

The extremities gradually grow colder

A general feeling of coldness, more or less marked, about the extremities (after one to two hours)

Hent. Fever

Feeling of heat in face

Sweat. Perspiration at night

Abundant and viscid sweat, all over

Conditions p. 280

Aggravation.

(Evening'), At 9 oclock, headache in frontal protuberance.

Footnotes p. 270

† Emile Zaepffel, These pour le Doctor, etc., Paris, 1869.

† Williams, abstracts in Boston M. and S. Jour., 71, 422. i I have heard of two cases of chronic constipation relieved by a dose of the bromide, and where have been taken large doses of the ordinary cathartics without producing an intestinal discharge; in other instances one or two doses have caused an evacuation of the bowels.

† Bulletin Generale de Therapuutique, tome 71, p. 102, 18G6.