Brominism is the first definite meas ure of toxicity, and, unfortunately, bromide of potassium and most of its congeners are eliminated very slowly; hence cumulative action. The cerebral symptoms are: a sense of mental weak ness, heaviness of the intellect, and fail ure of memory; partial aphasia; great somnolence and depression of spirits (H. C. Wood). With these there may be decided impairment of sensibility of the skin, to a degree that considerable heat applied elicits no complaint (Peeche). There is usually violent frontal head ache; but this often occurs ere the stage of brominism is reached; and bronchial catarrh and cough sometimes supervene. Where brominism assumes a chronic character, there is a nauseous, foetid breath, congestion and edema of uvula and faeces, disturbances of sensa tion as regards vision and audition, loss of appetite, and hallucinations either with or without mania. Routine prac tice in prescribing bromides may lead to mania.
The pernicious system of prescribing bromides recklessly for epilepsy and other nervous disorders may lead to severe mental diseases.
On taking bromides a considerable amount of bromine is retained in the body, and the output of it only comes to equal the intake when the organism has, as it were, become saturated with the element. If no more bromide be then taken, bromine excretion goes on very slowly, and its presence can be recognized in the urine for several weeks. Excre tion takes place chiefly through the kid neys, but it is also present in all the fluid secretions. While bromides are be ing taken, the amount of chlorides in the urine is greatly augmented, and from this the conclusion is drawn that bro mine ousts chlorine to a certain extent from its combinations in the body- tis sues and fluids. During the administra tion of bromides small quantities of iodine are found in the urine in some cases, and disappear when the bromides are stopped. The iodine seems to be de rived from that present in the thyroid gland, but this is not quite certain until further observations can be made. F. Fessel (Miinchener med. Woch., Sept. 26, '99).
A condition of the brain may be pro duced similar to that occasioned by ex cessive haemorrhage; i.e., an increased tendency to convulsive action (Clark, Gowers, Rosenbach). The action is not only on the cerebral circulation, but also in the cells of the gray matter of the cord.
Paresis is often induced, with in ability to walk, sometimes more marked on one side of the body than on the other and simulating hemiplegia; there may be failure of memory, going on to partial paresis, with involuntary move ments of bowels and bladder. In a case of Jacksonian epilepsy, in a child, a drachm of potassium bromide was given daily. The father, a druggist, reasoned that, if this amount kept the disease in check, 2 or 3 drachms during the same period ought to work a cure. But the
child speedily sank after the larger doses were instilled and became an imbecile. Also two children were taking bromide; one lost all memory of words and the other all idea of time.
Voisin, Stark, Kiernan, Moyer, Rock well, Seguin, Spitzka, Alexander, and others have reported cases of convulsions arising from traumatic epilepsy that, under the influence of bromides, were replaced by furor. Cases of grand mai and petit mai have been reported in which their use rendered the patients unmanageable, violent, homicidal, queru lous, irritable, and suspicious.
The last author quoted cites several more cases, eight in all. L. W. Baker, of Baldwinsville, three more. Laborde also observed priapism and sexual ex citement sometimes amounting to saty riasis follow the use of bromides. Win ters, of New York, has recorded many instances of visual hallucinations. Kier nan, of Chicago, and Numro, of Edin burgh, also observed marked aphrodisia. "That these untoward effects closely simulate the effect produced in epilepsy there can be no doubt, yet the weight of authority, and indeed the weight of evidence, is in favor of the opinion that these phenomena result most often from the suppression of epileptic explosions" (Bannister and Alexander).
"To give the bromides alone is to postpone the explosions and generally intensify them. The very fact that a sudden suppression of bromide admin istration is followed by a severe ex plosion is clear evidence that the drug acts rather like a load keeping down a safety valve." (Spitzka.) Not the least unpleasant sequelm both as regards patients and medical attendants—that supervene as the result of continuous bromide administration, even in what are often considered very moderate doses, are the manifestations of brominism seen upon the skin. These may range all the way from a simple erythema to a rubeoliform or scarlatini form rash, up to acne, pemphigus, fu runcular swellings, and most foul and stubborn ulcerations that, too often, per haps, are deemed evidences of a syph ilitic diathesis. These are, for the most part, distinctly traceable to morbid changes in the sebaceous glands, in turn induced by impeded capillary circula tion and obtunded nerve-fibrilla. Such eruptions, if not recognized, are very annoying to treat, and are practically impossible to relieve until the bromide is suspended and in great measure elim inated from the system. It is claimed that the simultaneous administration of arsenic tends to inhibit such sequel; but this is not, by any means, univer sally true. The late Brown-Sequard was accustomed to combine belladonna with bromides, which frequently proves a most effective measure.