KALI BROMATUM.

Potassium bromide.

Preparation , Triturations.

Authorities.

1 , Dr. Hœring, Inaug. Diss., Tubingen, 1838 (Hygea, 8, p. 547), took daily doses of 1 grain, afterwards increased; 2 , Dr. Hermerdinger, Inaug. Diss., Tubingen, 1838 (Hygea, 10, 449), took 1/2 drachm in water, fasting, and afterwards 1 drachm in six divided doses, during one day; 3 , Otto Græf, De Kali bromat., 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 , Laborde, experiment on self with 15 grammes, taken twice, Gaz. Méd. 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 , Amburger, 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. Méd. de Paris, June, 1850; 19 , Garrod, general effects, Med. Times and Gaz., 1864, p. 276; 20 , Bartholow, 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., April, 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 , Bazaine, "Bromism" in general produced in about ten days by 30 to 40-grain doses two or three times a day, Brit. Jour. of Hom., 27, 10; 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 1/2-drachm doses at 11 A.M. and 5 1/2 P.M., Brit. Med. Jour., Oct. 1869; 28 , Williams, effects in epileptic patients, all more or less insane, Brit. Jour. of Hom., 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 Psycol. 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 Buren, 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.; 42 a , same, a lady took an ounce in the course of a month; 43 , Dr. Fabret, 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 1/2 to 1 drachm three times a day in general paralysis of insane; 48 , Clarke and Amory, general effects, Monograph, Boston, 1874; 49 , C. Wesselhœft, 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 l'Eruptions de Brom. de Pot.," p. 70, general effects; 55 , same, effects in a boy with epilepsy of 1 1/2 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 1/2 grammes three times daily, Allg. Zeit. für Psychol., 1874; 62 , same, effects on an epileptic patient after ten days; 63 , Palm, poisoning of children by crystals, Med. Corresp. Blatt, 1852.

MIND

• Emotional.
• Delirium, 22.
• General delirium, with hallucinations; delusions about persecution and violence, 54.
• 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, and fallen to 60; skin cool; pupils contracted; his manner was excited and rambling, and his hands constantly busy, either in fumbling in his 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, 30.
• He imagined that he had been especially 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 o'clock 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), 33.
• She had the erroneous idea that she was deserted by all her friends, and as 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), 31.
• 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 which 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, .

HEAD

• Confusion and Vertigo.
• Confusion and heat of the head, 62.
• Vertigo, 2, 9.
• Vertigo, fainting, and nausea, followed by sound sleep, 39.
• Great vertigo with confusion of the head (after a few hours), 2.
• 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), 14.
• Dizziness, 18.
• Inability to stand erect on account of excessive dizziness, 62.
• The giddiness was generally accompanied with drowsiness and sometimes with actual stupor, 53. [70.]
• After the chief symptoms have disappeared, there remains a peculiar heaviness of the head, not amounting to actual headache, 14.
• General Head.
• Headache, 2, 16 ; (after a few days), 28 , etc.
• Dull headache, 25 ; (after large doses), 19.
• Headache, with heaviness, and pressure on forehead and temples, 18.
• 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, 53.
• Forehead.
• Pain in forehead and occiput (after one hour), 13.
• Headache in the right frontal protuberance, after a simple dinner; it increases at 9 P.M. (sixth day), 49.

EYE

• Objective.
• Expressionless gaze; lustreless eyes, 25.
• Hollow, fixed eyes, 54.
• Eye lost its lustre (after a few days), 28. [80.]
• Dull-looking eyes, 54.
• Bloodvessels on the fundus of the eye were enlarged, 61.
• 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, 17.
• Lids.
• Drooping of the eyelids, 54.
• Constant closing of the eyes, more noticed when sitting up than when lying down, 62.
• Ptosis, gradually becoming complete, so that the lids hang far over the eyeballs, 61.
• Conjunctiva.
• Conjunctiva often congested, 48.
• Sensibility of conjunctiva so deadened, that a finger may be passed with impunity on the surface of the eyeball, without producing winking, 25.
• Pupil.
• Dilatation of the pupils, 2.
• Dilated and uncontractile pupils, 48. [90.]
• Pupils dilated, and contract very sluggishly under the influence of a strong light, 25.
• Pupils contracted, 30 ; (fourth day), 33.
• Contraction of the pupils, 29, 41.
• Pupils contracted (fourth day), 33.
• Pupils strongly contracted, 39 ; (second day), 33.
• Pupils greatly contracted (after three days), 31.

EAR

• Hearing became disturbed, 53.
• Hearing weakened (after three days), 31.
• Hardness of hearing, 54.
• 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, 25.
• The ears do not hear (after toxic doses), 48.
• At night in bed, had roaring in the ears, synchronous with the pulse, 49.

NOSE. [110.]

• Nostrils full of thick mucus and yellow scabs, 34.
• The salt found in the nasal mucus (after half an hour), 13.
• Smell weakened (after three days), 31.

FACE

• Languid expression, 54.
• Wearied, anxious look (after a few days), 28.
• Looked queer (first evening), and as if frightened (second morning), 27.
• Dull, stupefied expression, 54.
• General aspect of hebetude and indifference (after toxic doses), 48.
• The expression of hebetude becomes first that of imbecility, and then that of idiocy (after toxic doses), 48.
• Yellow, cachectic complexion, 22. [120.]
• Dirty yellow complexion, 54.
• Face pale (second day), 33.
• Face pale, suffering, 63.
• Face exceedingly pale, 30.
• Face ashy pale (fourth day), 33.
• Face thin, 54.

MOUTH

• Gums.
• Painful gums, sometimes red and swollen, 54.
• Tongue.
• Tongue, red, dry, and enlarged (in a few hours), 54.
• Tongue moist and red at first, but after a few days it has a tendency to drying and browning, 25.
• Coated tongue (second day), 16. [130.]
• Foul breath and a white tongue , involving the edges as well as the dorsum , and not necessarily furred , with great languor and sleepiness, 52.
• Tongue presented every appearance of the effects of a corrosive poison, 23.
• Disordered action of the tongue; difficult speech, 54.
• General Mouth.
• Fetor in the mouth, 61.
• Dryness of the mouth, 48, 54, 62.
• Long-lasting dryness of the mouth (after the increase of saliva) occasioning a desire to drink, sometimes very urgent (after a few minutes), 14.
• Irritation of the mucous membrane of the mouth and fauces; the tongue was painful and the papillæ very prominent, with redness and burning through the whole of the mouth and fauces as after some acrid substance, 10.
• Saliva.
• Increased secretion of saliva, 62.
• Increased secretion of saliva, with frequent spitting (after a few minutes), 14.
• Transient increase of saliva and mucus in the mouth, 2. [140.]
• Slight increase of the salivary secretion (immediately), 14a.
• Profuse secretion of tenacious saliva, with fetor from the mouth, 61.
• Salivation, 16, 42a.
• Salivation and salt taste in the mouth, 48.
• Salivation, not copious, but merely disagreeable, 48.
• Ropy mucus on the tongue, lips, and inside the mouth, .

THROAT

• Some patients experience a peculiar sensation of dryness of the throat and neighboring parts, 19.
• Irritation in the mucous membrane of the throat and stomach (after 3 to 4 grammes, 60 grains daily), 43.
• Tickling in the throat, a short time after every dose, 8.
• Uvula.
• Œdema supervenes on congestion of the uvula and fauces (after a toxic dose), 48. [160.]
• Insensibility in the region of the velum palati and pharynx, 18.
• Anæsthesia of the velum palati, 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, 25.
• Fauces, Pharynx, and Œsophagus.
• Mucous membrane of fauces highly injected, 23.
• Anæsthesia of the fauces seems the last symptom to disappear, 25.
• Anæsthetic effect on the mucous membrane of the fauces and upper respiratory organs, by which their reflex action becomes diminished, 44.
• Moderate anæsthesia of the pharynx, 48.
• According to Voisin, the local anæsthesia 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, [Emile Zæpffel, Thèse pour le Doctorat, etc., Paris, 1869.] "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 no 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," .

STOMACH

• Appetite.
• Increased appetite, 7, 10.
• Appetite somewhat increased, 4.
• Appetite remains very good, patient takes his food very well, and dozes off immediately after, 25.
• Less appetite for breakfast, no appetite for dinner (fifth day), 49.
• Loss of appetite, 22.
• Anorexia, 52 ; (second day), 10.
• Thirst.
• Thirst, 2.
• Much thirst all day, but able to drink only a mouthful, as the cool water is unpleasant (fifth day), 49. [180.]
• Great thirst, 54.
• Intense thirst, and a craving for cold drinks, 25.
• Eructation.
• Eructations, 2, 16.
• Repeated eructations, 2 ; (after a few minutes), 14.
• Eructations without nausea (immediately), 14a.
• Nauseous eructations, and inclination to vomit, 1.
• Nausea and Vomiting.
• Nausea, 16, 39 ; (after one hour), 13.
• Nausea and vomiting, 43, 63.
• Sometimes slight nausea directly after a dose, which soon disappears, 48.
• The nausea and pain in stomach were most frequent when lying on left side, 13. [190.]
• Sickness (soon); (after a few days), 28.
• Sick and giddy, 47.
• Repeated retchings and emesis, 23.
• Vomiting, 18.
• Repeated serous vomiting, for nearly seven hours, 13.
• Vomiting of frothy mucus, 42a.
• Stomach.
• The stomach was weak for a long time afterwards, .

ABDOMEN

• Umbilical.
• Violent periodical pains in umbilical region, which is very sensitive to touch, without being distended (second day), 63.
• Colic-like pains in umbilical region (even after six or seven weeks), 63.
• General Abdomen.
• Rumbling, 2.
• Much flatulence (while taking the medicine), 49.
• Emission of flatulence, 2.
• Frequent emission of flatulence, 9. [210.]
• Emission of much flatulence, 9.
• Feeling of warmth in the abdomen, 2.
• Violent pain in the abdomen, 63.
• Pain following the course of the ascending colon, 8.
• Colic, 2, 5, 22, 16.
• Sudden colic disturbing the rest at night, 3.
• 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 diarrhœa during the day, 42.

RECTUM AND ANUS

• Tenesmus, once, 9.

STOOL

• Diarrhœa.
• Increased evacuation of the bowels, 1.
• Diarrhœa, 16, 54. [220.]
• Diarrhœa (in a few rare instances after continued doses), 48.
• Diarrhœa; on using cloths they were found to be stained of a violet color, 23.
• Purging, 13.
• Purgation, with abdominal pain of a dull aching character, 45.
• Hypercatharsis, repeated again and again each time the medicine was taken (in two cases), 28.
• 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 [Williams, abstracts in Boston M. and S. Jour., 71, 422.] 2 patients had to discontinue its use on this account, 48.
• Soft stools, 5.
• Stools softer than usual, 7, 9.
• Stools softer and more frequent, 3.
• Constipation.
• Constipation, 4, 8. [230.]
• Slight constipation (after continued doses), 48.
• Bowels sluggish in their action, but not very confined, 25.
• Fæces diminished in weight and usually procrastinated, 15.
• Dryness of the excreta of the intestinal canal follows its continued use, and the stools become dry, hard, and infrequent, 48 . [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.]

URINARY ORGANS

• Bladder.
• Feeling of vesical distension and irresistible desire to urinate (during the partial slumber), 14a.
• Micturition.
• Disposition to urinate, 16.
• Bowels were regular, with frequent desire to pass water, but which was, however, rather diminished in quantity (while taking the drug), 49.
• Frequent emission of thin yellowish urine, 5.
• Emission of a large quantity of clear yellowish urine, 3.
• Frequent and profuse emission of urine, 7. [240.]
• 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 beaker-glass; 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, 49.
• The quantity of urine passed in the twenty-four hours was increased. This was not due to the increased drinking of water, 15.
• Scanty micturition, 13.
• Urine.
• Increase of renal secretion (after continued doses), 48.
• Increased secretion of urine, 2, 8.
• Increased secretion of thin urine, 11.
• A moderate increase of the urinary secretion, during the morning or day after taking, 48.
• Copious secretion of urine, 3.
• Copious secretion of thin and clear urine, 4.
• Increased urine, 1. [250.]
• Increased amount of urine, 9.
• Profuse, thin, pale urine, peculiarly offensive, 6.
• 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.

SEXUAL ORGANS

• More or less debility of the genital organs, 18.
• Decline of sexual power (after long-continued use), 43. [260.]
• Sexual weakness degenerates into impotence (after a toxic dose), 48.
• It exerts a most powerful influence on the generative organs, lowering their functions in a remarkable degree, 19.
• During the partial slumber, especially if in bed, there 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, 14a.
• 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, 48.
• Diminishes and ultimately entirely neutralizes the sexual appetite, 20.
• From the beginning the sexual appetite fails; erections are rare and imperfect, and cease altogether after a few days, 25.
• Pain, swelling, and tenderness of the left testicle and cord (second day), 42.

RESPIRATORY ORGANS

• Laryngo-bronchial weakness, sometimes with cough, and sometimes with a changed or whispering voice, rarely with aphonia (after continued doses), 48.
• It appears to produce an anæsthetic condition of the larynx and pharynx, 19.
• Voice.
• Painful, exceedingly disagreeable hoarseness for a long time, most violent after he had taken 37 grains in nine days, 1. [270.]
• Faint voice, 54.
• The whispering voice sinks into aphonia (after toxic doses), 48.
• Hacking cough, 1.
• Dry, fatiguing cough, 22.
• 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 hooping-cough, 54.
• 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, 15.
• Vascular " bruit de souffle ," 54.
• Breath has a disagreeable odor, which seems peculiar to those who have been for any length of time under the influence of the drug, 45.
• Fetid or bromized breath (after continued doses), 48.
• The fetid breath becomes nauseous (after a toxic dose), 48. [280.]
• Respiration, without the stertor of opium or alcohol, is easy but slow (after toxic doses), 48.
• Respiration calm and tranquil, with occasional sighing, 25.
• Anxious respiration, 22.
• Difficult breathing, 16.

CHEST

• Symptoms of pulmonary catarrh, 54.
• Tightness of the chest, on breathing, 2.
• Oppression of the chest, 1.

HEART AND PULSE

• Heart's Action.
• Reduces the action of the heart and arteries, 20.
• Heart's beats lacking in energy, and its sounds distant and feeble (in its effects on the heart the drug seems to resemble Digitalis), 25.
• Heart's action feeble and intermitting, 47. [290.]
• The heart's action gradually grows feebler till it ceases altogether, 48.
• Heart's action very feeble, 46.
• Action of heart slow and fluttering (after a few days), 23.
• Heart's action slower and feebler (after toxic doses), 48.
• Pulse.
• Accelerated pulse, after awhile it was at times several beats slower than natural, 2.
• Pulse irritable and rapid, 63.
• Pulse small and very frequent, 22.
• Pulse slower, except during actual vomiting, 13.
• Small and slow pulse, 16.
• Pulse weak and slow, 25. [300.]
• Pulse notably slower as well as depressed, 14.
• Pulse, which normally was about 80, had fallen to 60, 30.
• Pulse much lowered (40 to 48), 18.
• Pulse very low, after the fever, 54.

BACK

• Pain in loins, 16.
• Pain in the region of the kidneys, 9.
• Pain, seemingly seated in the region of the kidneys, 8.

EXTREMITIES IN GENERAL

• Disordered action of the extremities, 54.
• A sort of muscular weariness and a bruised feeling in the limbs and loins (after waking), 14a.

SUPERIOR EXTREMITIES

• Trembling of the hands during voluntary motion, 54. [310.]
• When he raises his hands, as in the act of carrying something to his mouth, they tremble as if he had delirium tremens, 25.
• Handwriting shaky and indistinct, 54.
• Hands and fingers in constant action (second day), 33.
• Almost constant twitching of the fingers, and a busy occupation of them in matters of no importance (after three days), 31.

INFERIOR EXTREMITIES

• Gait unsteady (second day), 33.
• Unsteadiness of gait, so great that he was frequently taken for a drunken man, and on one occasion was arrested by the police, confined in a cell all night and fined the next morning, notwithstanding my statement of the facts to the police superintendent, 30.
• Great unsteadiness of gait for two months, then gradually disappearing, 35.
• Irregular in his gait, 47.
• Irregular gait, the patient reeling as though intoxicated, 45.
• Impaired locomotion, which, when the dose is excessive, resembles the gait of locomotor ataxia, 48. [320.]
• Reeling gait and general appearance of intoxication, 54.
• On beginning to walk, the first steps are undecided and staggering, but the gait soon recovers firmness (after waking), 14a.
• Staggering, 41.
• Staggering gait; walking is quite difficult, 54.
• Could not walk without staggering very much, 38.
• By degrees his gait becomes altered; he rolls and staggers like a drunken man; his limbs shake and bend under him, 25.
• Unable to walk (seventh day), 31.
• Could scarcely stand, and that only with support, 47.
• Unable to stand (fourth day), 33.
• Weakness in the lower extremities, and inability to stand erect (after three days), 31. [330.]
• Unusual weakness at the knees (after a few days), 28.
• Weakness of the extensors of the legs and feet, 37.

GENERAL SYMPTOMS

• Objective.
• An increase of destructive, without a corresponding increase of constructive metamorphosis, and consequent emaciation (after continued doses), 48.
• Diminishes the retrograde metamorphosis of tissue, 20.
• Diminution of mucous secretions generally, 48.
• 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, 48.
• Emaciation (after long-continued use), 43.
• General emaciation, 54.
• Considerable emaciation, 54.
• Great emaciation, 22. [340.]
• Very emaciated and weak, and of a peculiar pallid color, 51.
• Marasmus and emaciation, which endanger the life, may set in after too long-continued use, 44.
• 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 cerebro-spinal 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, 60.
• Better than usual, less tired, with more ability and inclination to walk than previously (while taking the drug), 49.
• Sedation, 20.
• Averse to exercise; sits and lounges about, 25.
• Invariably sat crouched up by the fireside all day, evidently devoid of all energy and resolution, 28.
• 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, 48.
• Languor of movements, 54.
• Great languor, 52. [350.]
• Unusually quiet, sitting languidly on a chair; he could not collect his thoughts to answer a question properly, 46.
• Lassitude (soon), .

SKIN

• Surface in general, and especially the skin of the face, of a dead-white color, 54.
• Considerable discoloration of the skin and mucous membranes, 54.

I

• A partial eruption, resembling both acne simplex and indurata ; preceded by considerable itching; appearing chiefly on the chest and face, especially 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 month, 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 of 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 face, to its great disfigurement. The duration of the pustules is also very variable, eight days, more or less; depending uniformly on the continuance of large doses; thus, when an extensive acne eruption has arisen from doses of 5 grammes or over, the number of pustules will be sensibly lessened if 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 mamillated 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 if 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 acne-like pustules, so closely aggregated as to amount to a swelling; they rise to a height of 3 or 4 millimetres, and their bases are indurated; the projections in a few days, partially collapse, their tips discharging a sero-purulent fluid. The centre of each pustule then presents an umbilicated 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 their 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 required for a year, easily gives 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 mamillations. I have seen two cases in which the swellings on the legs changed into atomic 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 constitutionally 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 œdematous 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 cases 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, 54.
• Affections of the skin seem to be especially seated in the sebaceous follicles and glans 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 millet seeds 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 smegma, 50.
• Acuminated itching, burning spots, in the skin, especially in the shoulder and in the region of the neck, showing some similarity to acne, 43.
• Some scattered acne pimples with yellow tips, 56.
• Acne, 48.
• (Dr. C. had seen an obstinate long-continued acne disappear entirely while the drug was being taken for a nervous affection), 24. [390.]
• Acne on the forehead, 62.
• 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 band of eruption up each side of the face 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 four penny piece, surrounded by slightly red areolæ, 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, .

SLEEP AND DREAMS

• Sleepiness.
• Great sleepiness, 52.
• When given in large medicinal doses, sleepiness or drowsiness and dull headache were occasionally noticed, 19.
• Great sleepiness; drop asleep soundly in a chair during daytime; if waked up, fall right asleep again, lasting for five days (sixth day), 49.
• Sleepiness, even to coma (after large and continued doses), 43.
• Inclined to doze, and often dropped off to sleep, 51.
• Drowsiness, 29, 33.
• Drowsiness, somnolence, and constant dropping off to sleep, 25.
• Extreme drowsiness; she slept all night, and would often fall asleep in her chair, and in most uncomfortable positions (after third day), 31. [410.]
• Somnolence, 37, 54.
• More or less somnolence (after continued doses), 48.
• Constant somnolence, 18.
• 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, 48.
• 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, 14.
• Sleep, 20.
• Deep sleep, 54.
• Sound sleep, lasting eight hours, 16.
• 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, 48.
• More profound slumber than usual (after 30 grs., when neither tired nor wakeful), 48. [420.]
• "The hypnotic action," says Voisin, [Bulletin Générale de Thérapeutique, tome 71, p. 102, 1866.] referring to his patients in the Bicêtre, "was very remarkable upon them, both by day and night; some were 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," 48.

FEVER

• Chilliness.
• Lowers the temperature, 20, 48.
• Skin cool, 30.
• Skin cold and clammy (after a few days), 28.
• Chilliness, 62.
• Shivering (after a few days), 28.
• Extremities cold, 48, 67.
• The extremities gradually grow colder, 48. [440.]
• A general feeling of coldness, more or less marked, about the extremities (after one two hours), 14.
• Heat.
• Fever, 54.
• Feeling of heat in face, 16.
• Sweat.
• Perspiration at night, 3.
• Abundant and viscid sweat, all over, 22.

CONDITIONS

• Aggravation.
• ( Evening ), At 9 o'clock, headache in frontal protuberance.

SUPPLEMENT: KALI BROMATUM. Authorities.

64 , Humerdinger die Wirkung des Broms und ein Brom-praparate, Inaug. Diss., Tubingen, 1838; 65 , Dr. David Lees, Hom. World, vol. xii, 1877, p. 371, a child, æt. nine months, took 9 drachms, in fourteen or fifteen days, for epileptic convulsions; 66 , B. Fincke, M.D., The Organon, vol. i, 1878, p. 343, a young surgeon took 10 grains in one dose, for excessive sexual excitement after mental overwork.

• Peculiar biting salt taste of the drug lasted a long time, 64.
• Frequent micturition, 64.
• He immediately had burning in stomach, going into aching, empty gone feeling relieved by eating, for from one to two days. Then urinary symptoms; passed water in immense quantities, with distress, as if so full that he could scarcely contain himself; frequent urination, very pale, watery, every five or ten minutes, for a week (in one day amounting to a gallon). The sixth or seventh day, suddenly, a neuralgia in spine came on, after throbbing from head to feet, worse in abdominal organs, commencing in lumbar region, spreading up to dorsal region, and down to coccyx, and going around the body half way, going into the intestines, and all through him; dull pain at the time, sometimes sharp twinges going up and down the marrow. Nothing would relieve the pain. Craving for wine. The very thought of tobacco nauseated him, though used to take a cigar after dinner. Port wine relieved the pain by marking him eat, though he threw up his dinner. The pain seemed to go away by that time (one to two days). He took one dose

Kali brom . 1 m. (Fincke) double graft, which did nothing while he had this pain, also

Nux vom . 1 m., which did not seem to act. He threw himself down, closed his eyes, seemed above the earth, as if he were in a higher plane (twenty minutes after taking), feeling quite happy, as if his happiness was not of the earth. The digestive symptoms commenced soon after taking. Aversion to coffee, which he used to drink. When the neuralgia left him these urinary symptoms commenced: pain on urinating, smarting, burning pain, sensation on urination as if a shot were forced from the bladder along the urethra, passing constantly large quantities of water. Just at the last drop of urine, spasmodic constriction of urethra about the lacuna, with real, sharp pain running along back in the bladder, like forcing a large instrument in a small place. Then a regular gonorrhœa set in, whitish-yellow discharge for two or three days (never had anything the like). Every second or third day the smarting came on late in the afternoon, and kept him awake all night. He now passes less water.

Canth . 2c. and Cann. sat . did. nothing. Only bathing the parts in ice-water gave relief. Since the gonorrhœa the sexual excitement subsided. The urinary symptoms irritated him most; he cannot do anything, cannot go into society. If he sees

Bromide of potassium , or any kind of Potash, it makes him sick in the stomach. Hands tremble. On November 9th gave him

Camphor (Borneo) 9 m. (Fincke) seven powders, one every night. On November 11th had an awful time, burning and smarting in urethra, could only get relief by injection of cold water. November 16th, to-day and yesterday passed much water without smarting, had not to get up at night. The urine was free from sugar and albumen. Last night, after a slight burning and a sensation of a ball passing forced from behind at the neck of the bladder, passed about 1/2 ounce of liquid like white of egg, with a little mucus like milk, without seminal smell (? prostatic). Since then everything is right, and he is himself again. Yesterday morning terrible pain in right eye, as if it were pressed out (Camphor symptom), 66.

• The convulsions disappeared as the eruption came out. Each spot of skin disease seemed to have commenced as a papule of acne. This enlarged and spread, and the elevated spots became united in areas. On these areas peculiar yellowish points then were developed beneath the surface, neither coalescing nor bursting. On the surface a crust appeared, which seemed due to dried secretion; and, where this was subjected to friction, the surface became peculiarly papillated. Especially characteristic were the yellowish points described. An interesting fact was that the rash did not make its appearance until four days after the drug had been given up, 65.