140 years ago: On the therapeutic uses of bromide of potassium
The therapeutic effects of bromide of potassium are seen with the greatest amount of certainty and clearness when it is given to those who are suffering from paroxysmal diseases.
The uses of this drug are, however, not limited to those affections, but may be observed in many others of which obvious spasm forms no part. It became a "fashionable" medicine a few years ago; and, like some of its predecessors in the circle of fashion, was soon over-rated, and misapplied; it failed to do in all cases what it had been said to do in some; occasionally it appeared to be mischievous, and often it seemed inert; and so, within the last few months, there have arisen those who entertain doubts as to its possessing real value in the treatment of disease.
Being confident, however, that it is one of the most important medicines that we possess, it will be well to illustrate, at the outset of this paper,– by a few cases, recorded as briefly as possible,– the fact of its definite utility. Having done this, it will be sufficient to give only the general results of its employment in other classes of disease, where the action of the medicine may be defined with a somewhat inferior degree of precision.
It is purposed, therefore, first to speak of the use of the bromide in the treatment of the following groups of diseases:– (1) Those marked by spasmodic contraction of the muscles. (2) Those characterised by disturbances of sensation. (3) Diseases displaying themselves in mental change; and (4) Affections of the vaso-motor system of nerves. A few remarks will then be offered on (5) the mode of action of the medicine; and (6) on bromism.
I. Of those diseases which are characterised by spasmodic movements, the action of bromide of potassium is most conspicuous in epilepsy; and of this fact, the following cases will afford sufficient illustration:–
Epilepsy.– A man, epileptic for eighteen years, his fits having commenced at puberty, and having recurred with great severity and at a high rate of frequency during the whole period, took bromide of potassium for the first time in January 1864; and from that date until this has never had a single seizure. The dose prescribed in this case was ten grains, to be taken three times daily; it was continued for nearly twelve months, and was then abandoned. There was no other medicine employed, nor was there any change made in the place or mode of living of the patient.
A lady, epileptic for eight years, the fits being of most distinctive character and of frequent but irregular occurrence; and who, during the intervals of attack, suffered much from "nervous feeling," great depression of spirits, incapacity for mental occupation, and constant "dread," commenced taking the bromide four years ago. Ten-grain doses were prescribed, and with the effect of prolonging the intervals between the attacks; but, as the seizures returned, the quantity was increased, and again the fits for a time disappeared. They returned, however, for the third time, and the dose was augmented further. Similar events happened until the quantity of bromide administered was thirty-five grains, three times daily. This dose was commenced a year and half ago, and since that period there has been no attack. The general health has been unimpaired, the nutrition of the body has been maintained, the menstrual functions have continued with perfect regularity, and almost the whole of the distressing feelings which formerly occupied the intervals of attack have disappeared.
A gentleman of middle age, overworked both mentally and physically, became epileptic four years ago. His attacks were of the severest kind, but during the intervals of their occurrence he presented no signs whatever of disease in any organ of the body. His attacks had been frequent, and uncontrolled by "change of air," freedom from toil, dietic regulation, and medicine. He began to take the bromide, in ten-grain doses, two years and a half ago, and immediately the fits ceased, and they have not returned. Here there was no change in the mode of living, but the individual referred to continued to do the same kind and amount of work that he had done before. The medicine was gradually diminished at the end of twelve months, and was discontinued a year ago.
The cases of epilepsy which have proved the most amenable to the action of bromide of potassium are those in which the attacks have been exclusively or prevailingly those of the severer type, le haut mal; in which the rate of recurrence has been rapid; and in which the fits have occurred mainly during the day; whereas, on the contrary, those that have resisted its action have been marked by a predominance of slight or abortive seizures, le petit mal; or have exhibited the severer attacks at rare intervals, or have suffered from them only during the night.1
These statements, it must be remembered, are not absolute; they express only the general results of observation on many hundreds of cases; and particular exceptions occur to them in each direction.
1 See Dr. Duckworth Williams' paper "On the Efficacy of Bromide of Potassium in Epilepsy and Psychical Affections."