Kalium bromatum

SALTS OF POTASH.

Toxicologically, potash may be of some interest to you when, by accident, caustic potash is swallowed. Its great affinity for water makes it attack the tissues with great avidity, producing very deep escharotic effects. It has more power to penetrate the tissues than have some of the other caustics, nitrate of silver for instance; hence, it has been selected as the caustic for use when it is desired to reach far into the parenchyma of a part, as in the treatment of carbuncle; when a large portion of tissue has become gangrenous and a slough must be produced, caustic potash is used. The tissues thus acted upon have a greasy appearance, which is due to the formation of a soap made from the combination of the fats with the potash. Thus it differs materially in its action from the mineral acids, which make the tissues dry and dark, almost like a mass of tinder.

When swallowed by accident, for it is seldom used for suicidal purposes, the effects of caustic potash are violent. It causes such violent contraction of the stomach that what little of it gets that far is immediately ejected by violent vomiting. If the amount of caustic taken is sufficient, it causes a brownish film over the mucous membrane, or there may be spots here and there in the mouth and throat which are denuded of their epithelium. The inflammatory process may increase to such an extent that these spots ulcerate, and as they heal they form cicatricial tissue with the subsequent unfortunate contraction and stricture of the part.

The antidotal treatment to such accidents is both chemical and mechanical; chemical, to relieve the effect of the drug, and mechanical, to relieve the trouble that remains. Vinegar, lemon-juice and large draughts of mucilaginous drinks are mostly relied upon to relieve the acute symptoms of this poisoning.

But there are many cases of slow poisoning with the potash salts, particularly when our allopathic friends use bromide of potassium so extensively. We, therefore, have the chronic effects of this to treat. These may require to antidote them: Hepar, which is an antidote to the metals in general; Sulphur, and other remedies may be called for according to the symptoms present.

It has been determined by experiments on mammals, that potash, particularly the carbonate, acts paralyzingly on the muscles. This accounts for the general weakness which belongs to all potash preparations. This paralyzing effect is very manifest in the case of the heart muscle, which becomes early affected in poisoning with potash, the animal eventually dying with the heart in diastole, that is, the heart is widely dilated at the moment it ceases to beat. With this hint, you would expect to find potash salts of use in great muscular weakness, in what has been termed paresis, such exhaustion as accompanies convalescence from protracted disease as typhoid fever.

We have it on the authority of Dr. Hering, that mushrooms contain a large percentage of potash, and are therefore to be recommended as an article of diet in cases of exhaustion.

Kali Bromatum.

The first potash preparation we will consider is Kali bromatum or Bromide of Potassium. We find that this drug is antidoted by Hepar mainly. It has some few analogous or concordant remedies, Ambra grisea, Hyoscyamus, Stramonium, Tarentula and Mygale.

Bromide of Potassium acts mainly upon the nervous system and acts, too, in two opposite directions. Primarily, it decreases reflex action; secondarily, it depresses the mind. This property of the drug to modify reflex action has led to its extravagant use in the treatment of epilepsy. It is given in progressively increasing doses until the system is affected by what is known as bromism. When the system has become saturated with the drug, then it is discontinued for awhile. The first effect of the drug seems to be to increase reflex action, particularly reflex motor action, and it is on this quality of the Bromide of Potassium that the allopath bases his prescription. Every little disturbance in the periphery of the nerves, every little alteration in the function of an organ, is at once reflected to the nervous centres, and produces some other disturbance, either an uncomfortable sensation, twitching of muscles, anxiety, headache or even absolute convulsions. This is the first condition of the Bromide of Potassium. You know that this is the starting point of almost all convulsions. Witness for instance, a case of eclampsia, where the pressure of the child on some of the nerves in the pelvis or against an undilating os, causes spasms; or still another case, where some indigestible substance in the stomach produces convulsions. This reminds you at once of Stramonium, in which a bright light, by affecting the retina, reflects the irritation to the brain and causes convulsions.

As a result of this oversensitiveness to external impressions, we have quite a number of characteristics of the Bromide of Potassium. Many of these are symptoms of the drug calling for its exhibition in acute mania, when there are sleeplessness and strange imaginations. The patient imagines that he will be poisoned; that he is pursued by some demon; that he is hated by everybody, or that his honor is at stake. Some such impression acts on the mind irresistibly, and causes him to resort to violent procedures; thus, he will try to commit suicide in order to avoid the supposed danger. All this time, the pupils are dilated, and the face bright red and expressive of anguish and fear. The body trembles, and the muscles twitch in various parts of the body. You see how this resembles Hyoscyamus, both being parallel remedies in this form of disease.

Kali bromatum has also acted very well in the night-terrors of children, when from over excitement of the brain, whether it be reflex from dentition or worms, or even from affection of the brain itself, the child shrieks out in its sleep, and if old enough, will complain of seeing hobgoblins, ghosts or something of that kind. Even when that symptom occurs in impending dropsy of the brain, Bromide of Potassium may be the remedy.

We have another condition calling for Kali bromatum, and this seems to be an irritability of the nerves, not only of the brain, but of the whole body. This irritability is expressed by the following symptom: The patient is nervous and cannot sleep, and feels better when engaged at some work. He is either busy playing with his fingers or he is walking about, or in someway occupying his mind or body in some exertion; then he feels better. Simple sleeplessness will not be relieved by Kali bromatum unless there is this relief from activity or motion.

In this respect, I find it similar to Tarentula, which also has this irritation of the periphery of the nerves relieved by exercise and by rubbing. The patient plays with her dress, or with her watch-chain? as if to work off this over-irritation of the peripheral nerves. Even in the case of the headache of this remedy, the patient rubs the head against the pillow for relief.

Another remedy which is similar to Kali bromatum in this overexcitability, is Ambra grisea, which has this same sensitiveness to external impressions, the slightest influence causing excitement and difficulty in breathing. Ambra grisea, however, almost always has some sort of vertigo associated with its other symptoms. It is a very quick-acting drug.

Conversely to this primary action of Kali bromatum, we have another, one of great depression of the cerebro-spinal nervous system. Thus we find it producing absolute loss of memory. The patient cannot remember words particularly. Associated with this symptom we find a distressing melancholy; everything looks dark and gloomy. He cares nothing for anybody or for his occupation. This condition of things often follows excesses in venery, in which case Kali bromatum is an excellent remedy.

There is also a sort of ataxia developed. The patient seems to be unable to manage his legs as he should. There are numbness and tingling in the legs and in the spine; this symptom being accompanied, in the first stages, by an increase in the sexual appetite, but as the case advances it is associated with absence of erection and, too, frequent nightly emission of semen, thus increasing the melancholy.

You will find Bromide of Potassium indicated for business men who have worked long and hard, who have pored over difficult problems until they have this dizziness, this staggering when they walk, and this benumbed feeling in the brain. It was only yesterday that I prescribed it for a business man on Third street, who has been working himself almost to death. I expect that it will relieve him promptly and effectually. He said that when he had been working at his books he would get a numbness in the back of the head, and a certain indescribable terrified feeling, as though he was going to lose his senses. Good results might also be obtained in this case by the galvanic current, the positive electrode being applied to the cervical region and the negative on the vertex. But Kali bromatum will give a more permanent relief.

Now, a word about Kali bromatum as an anti-epileptic remedy. I do not believe that it ever cured epilepsy. In almost all cases in which it has been given, it has not cured but simply suppressed the disease, and thus has produced a worse condition than the one previously existing, namely, imbecility.

Kali bromatum produces lesions of the skin. Its long-continued use gives rise to little, hard, dark red papules on the face, surrounded by little vesicles and ending in suppuration. We may, therefore, use the drug in acne, particularly that resulting from masturbation.

Another form of eruption which the Kali bromatum produces is a livid blotch as large as one's thumbnail, covered with scales, and having in its centre a yellowish appearance as if it were suppurating. After a while it does suppurate and discharge, leaving a central depression, something like that of the small-pox pustule.

Still a third form of eruption, is an eczema which evidently arises from the action of Kali bromatum on the sebaceous or sudoriferous glands, causing an abscess in each of these and developing a scaly eruption.