Reynolds. I have repeatedly seen cures, in the strictest sense of the word, result from its employment, after the failure moreover, in many cases, of other remedies. Not only have severe fits ceased to return under its use, but the general health of patients, and more especially their mental condition, which had seriously suffered, have been completely restored.

Years have elapsed in certain instances since the occurrence of a fit, and individuals who had, owing to the frequency and severity of their attacks, been rendered incapacitated for their employment, have been enabled to resume their occupations and continue them without interruption.

Some patients have been benefited but not cured. The fits in such have been rendered less frequent in their occurrence, and less severe, but have not been entirely removed. Still, in these cases the bromide of potassium has been truly the summum remedium. No regulation of diet, no peculiar stringency of regimen, no other remedy than bromide of potassium -and many remedies have been tried-has exerted the like beneficial influence. Accordingly, it has in such cases been continued for the purpose, as you and Dr. Hughlings Jackson have observed, of reducing the frequency and severity of the fits. Some cases of epilepsy have in my hands been in no respect benefited by the bromide of potassium. A few have apparently been aggravated. I have not been able to satisfy myself of the reason for this varied but exceptional experience. It is, however, a common experience in the use of other admirable remedies. Nullum medicamentum est idem omnibus.

Looking back upon my experience of epilepsy, I feel inclined to remark that, were I deprived of the bromide of potassium, I should conclude that my best hope of being useful to the sufferers from this last disease had been taken away. I cordially embrace the aphoristic deliverance of the authority whom you quote in the concluding sentence of your paper: "It has changed the whole prognostic significance of epileptic attacks."

2. Insomnia. In the procuring of sleep, bromide of potassium may be said to fall far short of opium, chloral, henbane, and other narcotics; and yet in many cases of insomnia it is superior as a remedy to the whole of these. Its innocency is

in the first place to be set against their potency, not unmixed as that potency is with injury or even danger.

In the sleeplessness which precedes mental shock, as is occasioned by long-continued mental strain or by worry, the bromide of potassium in full dose is oftentimes singularly efficacious, not only procuring much-needed sleep, but tranquillising the whole nervous system, and rendering the individual, otherwise quite unfit, capable of mental exertion.

I have repeatedly prescribed the remedy with the happiest results in cases of insomnia accompanied by general restlessness and incapacity for exertion, consequent upon long-sustained mental effort with anxiety in professional men, and on prolonged devotion to business in persons following different kinds of mercantile pursuits, in whom rest, change of air and scene, the most careful attention to diet and regimen, including treatment in hydropathic establishments, and the use of other drugs, had entirely failed to produce any good result. I do not affirm that the bromide of potassium always succeeds, or that it has always succeeded in such cases. I entirely concur in your observation that the insomnia of aged persons is apt to be aggravated by the bromide of potassium, although I have not found it to be always so, as your experience appears to have been. In one case of an old lady the remedy certainly did harm. She, however, had notable calcareous degeneration of the arterial tissues; and from my observations in her case and in other old persons, I have been led to surmise that the condition in question interferes with the physiological action of the salt, and with its therapeutic action likewise. Bromide of potassium is believed to contract the minute vessels, and if degeneration of their walls exists to a marked degree, in failing to produce this effect it is possible that the presence of the salt in the blood may excite cerebral disturbance in place of quelling it. Whether this theory be correct or not, I have for a considerable time avoided the use of bromide of potassium in old people whose vessels were evidently the seat of general atheromatous degeneration, but have prescribed it in the insomnia of the aged when this morbid condition of the vascular system was not conspicuous.

A further and most important use of bromide of potassium is as an adjunct to chloral. I have found 20 grains of the



former greatly increase the efficiency of a like dose of the latter.

The insomnia of delirium tremens is often overcome by large and frequently repeated doses of bromide of potassium, and so also is the sleepless excitement of puerperal mania. In these maladies the combination of bromide of potassium and chloral is chiefly to be recommended.

I have had occasion to verify the important observation of Dr. Begbie, that the craving for alcoholic stimulants which is so distressing a feature of dypsomania, is to a certain extent, even in some bad cases, and to a much greater degree in the milder, restrained by bromide of potassium.

3. Spasmodic Diseases.-In controlling habitual cramps of the lower extremities, I have found no remedy so useful as bromide of potassium; and undoubtedly the very distressing cramps of the formidable Asiatic cholera were found during the last prevalence of that disease to be subject to its influence.

In spasmodic asthma I have had a considerable experience of bromide of potassium, and have here but to rank its virtues very highly. In a review of the late lamented Dr. Hyde Salter's excellent work on asthma, undertaken at the request of my friend Dr. Sanders, then editor (1869) of the Edinburgh Medical Journal, I took occasion to express a favourable opinion of this salt as a remedy in asthma, and, at the same time, surprise that it had not even been named by Dr. Salter.

Perhaps in the treatment of asthma no remedy has appeared to me so useful as the iodide of potassium, but in my experience bromide of potassium has effected a cure when the iodide has failed. The union of these two salts, and their combination with arsenic, has been still more efficacious.

4. In the incontinence of urine of young children, bromide of potassium has answered when even belladonna had not succeeded, and these two remedies are probably the most available in this often troublesome disorder.

A less experience of its use in the following diseases has led me to the conclusion that in each of them the bromide of potassium is a remedy well deserving trial :—Hysteria, more especially its convulsive forms (in these Sir Charles Locock had reliable proof of its value), gonorrhoea, and certain non-malignant en

largements of the liver and spleen, the former more especially when connected with the too free use of alcoholic drinks.

I forbear from mentioning the diseases in which the use of bromide of potassium has been followed by results either negative or wholly unsatisfactory. Let me, however, state that I have grave doubts of its being, in the strict sense of the term, a febrifuge. In relieving the restlessness and insomnia of the febrile state, it unquestionably does good: but such therapeutic action does not entitle bromide of potassium to rank as an antipyretic.

I agree to the fullest extent in your judgment of the value of such articles as that of Professor Binz, in forcing us to scrutinise our grounds of belief in the action of remedies with additional rigour. Although I regard Professor Binz as essentially wrong, it will be my duty, after reading his paper, to reconsider the position I have been led to assume.

Believe me, dear Dr. Anstie, yours sincerely,





Late House Surgeon, Kidderminster Infirmary.

SOME three or four years ago, when engaged in investigating the therapeutic action of the bromide of potassium, I was so strongly impressed with its apparent adaptability to the treatment of gonorrhoea, that I determined to employ it in that disease whenever a suitable case came under my care. The success which followed its first administration was sufficiently gratifying to induce me to test its efficacy more fully as further opportunities offered. This I have done on various occasions since that time, with results which I can conscientiously characterise as uniformly satisfactory. Unfortunately, my opportunities have not been so numerous as might be desired, on account of the comparatively limited number of patients treated for this disease at the institution with which I was formerly connected. For this reason, as well as from the difficulty which must always exist in accurately determining the post hoc from the propter hoc, in a disease which per se tends towards recovery, I cannot speak so authoritatively as I might otherwise wish. I will therefore restrict myself to a plain statement of its apparent modus operandi, of the compli cations in which I have found it most useful, and the mode of procedure adopted in its administration.

ITS MODUS OPERANDI.-As the result of careful and repeated experiments, bromide of potassium is said to have the power, amongst its various other properties, of—

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