Case of a robust, well-developed child, 3 years of age, suffering from an ulcer on calf of leg, resembling a boil, covered at the apex with raspberry granulations bathed in adhesive, sanious pus. In a few days the ulcer was surrounded with acne pustules, which coalesced with the original lesion until the latter covered a large part of the gastrocnemius mus cle; skin tawny or bronze; breath very offensive. The pustules were im mense, and resembled varicella, more than acne. Finally the sores threatened the whole leg below the knee. It was found the child occasionally suffered at tacks of vertigo, for which a neighboring physician with a reputation for "curing fits" had prescribed large doses of am monium bromide, under the supposition that he was treating a case of epilepsy.
Fullerton (Memphis Med. Monthly, Oct., '97). (See colored plate.) The evidence is overwhelming that the bromides are not the harmless medic aments that they are generally assumed to be; also that their present universal and routine employment should be abandoned for more rational and physio logical methods of procedure. When a patient who has been taking bromides for some time complains of a salty or bitter taste soon after the drug has been ingested, especially if there is increased secretion of saliva, suggestions of foetid breath, or a burning sensation in the mouth, whether accompanied by nausea and eructations or not, such should be regarded as evidence of impending bro mism, and measures taken accordingly. It must be remembered, moreover, that these evidences may result from the administration of ordinary medicinal doses-10 to 20 grains in the adult— when frequently repeated, since the emunctories are not able to excrete this amount. Interstitial nephritis is a com mon sequel to brominism.
Of all the bromine salts, that of am monium is the most apt to induce tox icity, since the effects upon the sensory portion of the spinal cord are most marked. Bromides of lithium, potas sium, and calcium rank, respectively, second, third, and fourth as regards poisonous qualities. Collapse under either the ammonium or potassium salt may arise either through the base or the bromine constituent; but the potassium bromide is more apt to be at fault in this respect. It is sometimes a difficult matter to determine where the blame should rest; but withdrawal of the potassium bromide, substituting there for another salt; that of sodium, for in stance,—may lead to definite decision. But the most innocuous (apparently) of bromine salts, when long-continued or pushed to extremes, are apt to induce collapse; and fatal pathological changes in both kidney and liver have been ascribed to their use, with considerable reason and probability. Calcium bro mide is claimed to be the least depress ing, but this is not altogether borne out by long experience in its use.
Case of infant, subject of a bromide eruption. Child when brought for ment was 7 months old, irritable, and dentition was in progress. It was very feverish and would not sleep; stools were offensive. A simple carminative mixture was given, 2 grains of bromide of ammonium being added. Two days after commencing this, the rash peared, and was well marked ou the forehead, and there was an extension to the scalp and to some extent to other parts of the body. The child had been very greatly relieved by the treatment, although the rash was still well marked on the tenth clay of treatment. Seymour Taylor (Brit. Jour. of Derm., May, '9S). Lithium bromide requires to be ministered in larger doses than its geners, and often proves the most tating of any to the digestive system. The strontium salt is least disturbing to the stomach when continuously istered for considerable periods, and by many held the least likely to induce bromism; indeed, H. C. Wood believes it stimulates appetite and increases the activity of the digestive organs, which, however true of small and medium doses, at moderate intervals, is not a fact regarding medium doses with brief tervals long continued or larger doses. The chief advantage of the salt is that its base is practically non-toxic. Barium bromide may be dismissed with the ment that it offers no advantages over the other bromide salts, and it has the marked disadvantage of possessing a very poisonous base. It is also claimed for this salt that it stimulates mucous membrane, improves appetite and diges tion, etc., and though this is, in a meas ure, true, such are referable to the metallic base rather than the acid source.
Sodium bromide is undoubtedly the most convenient, and to considerable degree the most safe of the bromide salts. Suitably diluted, it is no more disagreeable to the palate than the bulk of mineral waters, and it is, moreover, when accompanied by abundance of fluid, almost as readily eliminated. It must be remembered, in employing this drug, that it is not only essential, but of paramount importance, that the system be continually saturated, and flushed, so to speak, with water in abundance. Though some doubt its efficacy as compared with the ammo nium, calcium, and potassium salts, it certainly is least depressing to both cir culation and nervous system, and less irritating to the emunctories. In epi lepsy it is questionable if the results desired are not those that accrue to toxicity rather than those of purely remedial character, for here free stimu lation appears to inhibit prevention of paroxysms. But as a nerve-sedative purely, continued experience with so dium bromide invariably leads to in creasing favor on the part of both pre scriber and patient, until the verdict ulti mately becomes overwhelmingly positive.