Bromalhydrate in large doses is a poison of great intensity, death rapidly resulting from paralysis of heart and sometimes of respiration also, preceded by minutely-contracted pupils, marked dyspncea, and general convulsions. It lowers blood-pressure by powerfully de pressing the circulation and vasomotor centres; it is equally depressant to the cord, especially the motor columns thereof. When employed in hypnotic doses, sleep is induced by direct action on the cerebrum, causing brain-anremia. Larger, but non-toxic, doses induce distinct lowering of body-temperature. Like chloral, to which it was expected it would prove an analogue, it is antisep tic; and it is likewise markedly and painfully irritant to mucous membranes and raw surface. It is eliminated by the kidneys but slowly, and in the form of urobromic acid.
Bromalin, inasmuch as it contains only about half as much bromine as potassium bromide, requires to be given in large doses, but its effects are sup posed to be identical with the latter. It is claimed, moreover, that it is less prone to provoke unpleasant sequelce; but clinical experience is not yet suffi ciently ample to permit of drawing definite d&luctions.
Bromalin used in two cases of well pronounced bromine exanthema. Al though complete disappearance of the ex anthema was not brought about by the remedy, yet a favorable effect was exer cised by the bromalin, which exhibited a more powerful sedative action than the potassium bromide previously used. Bromalin is the only remedy that per fectly replaces the bromides of the al kalies and that is almost entirely free from the by-effects of the latter. Biihme (E. Merck's 1S9S Bericht).
Bromamide evinces its chief activity upon the cerebrum, which it materially depresses; hence its reputation as an hypnotic; nevertheless, it is inferior to many other drugs in this respect. In larger doses it is more markedly de pressant, exerting its action upon the spinal cord, whereby it becomes an anal gesic. In medium doses it stimulates the respiratory centres; but here, again, when pushed to the verge of toxicity, an opposite result accrues that may re sult in total paralysis. In small doses it influences the circulation but little; but in larger depresses the heart, and, if increased, the action of the organ is entirely suspended. Thus it is a remedy far more powerful for evil than good, and furthermore there is little confidence to be placed therein, since, once exposed to air and light, chemical changes take place whereby it develops greater tox icity. A dose taken from one container
to-day that appears harmless, if repeated a week later may prove dangerous. Until more is known of the product, and until its manufacture and preservation can be encompassed by greater safeguards, suring stability and uniformity, the drug is best relegated to the list of curious chemicals.
Bromoform is best known for its ames thetic properties, but is sometimes ap plied to relieve the pain accruing to cer tain morbid ulcers, and here appears to be both an antiseptic and a local anes thetic. After inhalation it may be de tected in the form of hydrobromic acid in the urine. It is highly toxic, more over, and induces symptoms of collapse, accompanied by great weakness, cya nosis, dilated and fixed pupils, and cold ness of extremities, but seems to be easily eliminated from the system under the use of stimulants and tepid baths.
Case of a child, 10 months old, that took by inadvertence about a drachm of bromoform. In a short time slight cya nosis had developed, the pupils were pro foundly contracted and phenomena of respiratory and cardiac paralysis had made their appearance. The tongue pre sented a brownish discoloration, and the breath the characteristic odor. Artificial respiration was at once instituted, and the cutaneous surface was stimulated through hot bathing and cold douches to the head. the tongue meanwhile be ing pulled forward rhythmically. These measures were maintained for two hours. when an injection of ether was made. This was followed by trismus and spasms of the extremities. The injection was, however, repeated twice at intervals of half an hour, and gradually improvement began to set in. Van 136mmell (Deut. med. No. 3, '96).
It is probable that in the system bromoform gives origin to chloroform. Rembe (Der Kinderarzt, viii, 49, '97).
Bromoform poisoning in a case of per tussis in an infant. The bromoform was given in a prescription with syrup of orange-peel, alcohol, and water. As the specific gravity of bromoform was greater than that of the other ingredients in the mixture, it naturally sank to the bottom of the bottle, and the mixture, in order that it be properly given, should have been thoroughly shaken before adminis tering it. This not having been done, the bromoform precipitated, and must have been given in one dose in the last tea spoonful contained in the bottle. This showed the importance of prescribing this drug in its pure form, without the addition of any diluent. Louis Fischer (Annals of Gynec. and Fed., June, '97).