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1. Diminishing the secreting functions of all mucous surfaces. 2. Acting as a direct sedative to all the nerves which supply the mucous membranes.
3. Increasing the flow of urine.
4. Acting as a direct sedative to the organs of generation. It will be found to act beneficially in all the four foregoing ways. By acting as a direct sedative to the organs of generation, it prevents an increased flow of blood to the parts, thus preventing engorgement, with subsequent increased inflammation, so often followed by exudation and its train of ugly after-symptoms. Thus, through its power of diminishing the secreting functions of all mucous surfaces and acting as a direct sedative to all the nerves which supply them, it limits the gonorrhoeal discharge and relieves the pain in micturition, by rendering the urethra less susceptible of irritation. In common with other remedies which augment the secretion of urine, the bromide of potassium renders this fluid less stimulating, by increasing its flow. It will thus be found serviceable throughout the whole course of the disease, but more especially in the inflammatory stage, in which so many other remedies are debarred.
This salt seems to have the power of diminishing the irritability of mucous membranes, not only when taken internally, but also when applied topically, for, according to Dr. Ringer, some writers aver "that merely brushing the pharynx and soft palate with a solution is sufficient to quell the irritability of these parts, so as to enable a laryngoscopic examination to be made with ease." Assuming such to be the case, it may naturally be inferred that a similar effect would be produced by its topical application to the inflamed urethra. This, I believe, will be found to be the case, for which reason an injection is recommended, as will be seen when its mode of administration comes to be considered.
COMPLICATIONS.-It may be used with advantage in some of the complications to which gonorrhoea gives rise, especially in that distressing and frequently troublesome one, chordee. For by reason of its power as a direct sedative of the organs of generation, it subdues the sexual appetite and prevents any tendency to erection, which, as is well knownwhen inflammation has extended to the corpus spongiosum
urethræ, and the cells are glued together by the effusion of coagulable lymph-is sure to produce this painful effect.
It will also be found useful in the third stage, when the disease has degenerated into a gleet.
MODE OF ADMINISTRATION.-As soon as a patient complains of gonorrhoea, the bromide of potassium should be immediately commenced, and continued throughout the duration of the disease. As it is said to increase the acidity of the urine, a condition not at all desirable, some alkaline bicarbonate should be combined with it to counteract this tendency. The following formula has been found useful:—
B. Potassæ bicarbonatis gr. 60
Potassii bromidi gr. 90—120
Mis. fiat mistura.
One-sixth part of this mixture to be taken three times a day, and once during the night, should the patient happen to be awake.
Care should be taken not to administer a dose whilst a meal is in process of digestion in the stomach, as it may, by neutralising the gastric juice, interfere with the conversion of the food into chyme.
If the disease is in the first stage, an injection of the salt is ordered and recommended to be used as frequently as opportunities allow. The following is the usual form and strength in which I employ it:
B. Potassii bromidi gr. 120.
Glycerini f. 3ss
Aquæ distillatæ f. 3 vss
Mis. fiat injectio.
One syringeful to be used every four hours.
When the discharge has assumed the form of gleet, a similar injection, associated or not as may be thought advisable with some astringent, will be found useful. In addition, I am accustomed to administer during this latter stage from fifteen to twenty grain doses, three times a day, combined with fifteen minims of the tincture of the perchloride of iron, and dissolved in some suitable menstruum.
[N.B.—I see no reason why an injection of the bromide should be contra-indicated in the inflammatory stage, but, on the contrary, consider its anesthetic properties (when applied locally) as likely to be of much service. I am, however, unable to speak from experience, never having made use of it in this stage.]
When there is any disposition to painful erections or chordee, a draught containing about half a drachm in an ounce of camphor mixture, administered at bedtime, will be found to allay this tendency almost to a certainty. In this complication its effect seems magical, and has only to be tried to be recognised as a boon of inestimable value.
There are certain accessories which should not be neglected in this, any more than in any other plan of treatment. The bowels should be carefully regulated, the proper diet prescribed, and a total abstinence from beer and other stimulants insisted on. Rest should be enjoined, and over-exertion strictly avoided. The testicles should be supported by a suspensory bandage, and the genitals bathed from time to time, especially before retiring to rest. The flow of urine may be increased by the free use of diluents, as linseed tea, barley water, &c.
My object in being thus precise in detailing its mode of administration has been to endeavour to induce others, who enjoy a far wider field for experiment than mine, to make use of the drug; when I feel confident its value as an additional agent towards the cure of a loathsome disease will be appreciated, and my views herein expressed verified. In the whole range of the Pharmacopoeia there is no drug which in my opinion primâ facie promises such happy results in the treatment of gonorrhoea. For, as has already been pointed out, not only do we find it to have the power of diminishing the secretions and assuaging the pain of all mucous membranes, but also to produce a special sedative effect upon the organs of generation. of generation. Undue administration has been said to give rise to debility, but exhibited in the doses here recommended, all fear of this kind may be laid aside. Indeed, from considerable experience in its administration in large doses, continued over a lengthened period for the relief of epilepsy, I am inclined to think that its ill effects have been greatly exaggerated.
SINGULAR CASE OF CHLORAL-POISONING.
BY DR. ANSTIE.
THE following case, which has lately come under my observation, presents some features which have not, I believe, been yet described. It is a remarkable instance of the continued use of chloral in enormous quantities, the final dose, which brought matters to a crisis, being quite unparalleled in medical literature, so far as I am aware. And the symptoms which were produced are in several respects unlike anything which has been recorded as a result of the abuse of chloral.
In December last I was summoned to attend a medical man, whom I found in bed and in an alarming condition. He was pale, haggard, with suffused eyes; he tossed about incessantly and complained of agonising pains in all his limbs. He told me that he had scarcely slept at all for a week, except on the day previous to my visit, and concluded his preliminary statement by informing me that he traced the whole of his miseries to the abuse of chloral.
His story in detail, as I afterwards obtained it, is substantially as follows. About February 1st, 1873, he began the use of hydrate of chloral, in 3ss doses, in order to procure sleep at a time when he was harassed by great anxieties. About this time he was attacked with modified small-pox, followed by scattered abscesses; and this led to his continuing the chloral into the month of April, sometimes increasing the usual dose, and sometimes taking a second if he awoke very soon. About two months from the time of his first employing the drug, he noticed the first unpleasant effect; his eyes became "inflamed
and weakened, and there was burning lachrymation." He left off the habitual use of chloral, but took it, perhaps, one night in three or four, when wakeful. The usual dose, at this time, he thinks, was about 3j, from April to August.
In August, while travelling, he recommenced the habitual use of chloral, and then first took it during the day, as a calmative, once, twice, or thrice daily. About the first of September he noticed that the use of any alcoholic stimulant, even claret in very small quantities, would flush his whole face, suffuse his eyes, and bring on almost at once a severe headache, which was almost always at the back of the head, "about the cerebellum:" this peculiarity continued up to the time when I saw him. During the whole interval he had continued to take chloral with the exception of one week for which he abandoned it: he then did not sleep, for five nights, until 4 A.M., when he would doze off, and waken moist with perspiration. It was about the beginning of December when he first realised with accuracy what quantities of chloral he had been taking, as he had previously been accustomed to take it pretty much by guess-work. He found that he had been taking over half an ounce in the twenty-four hours, some days more than others. His appetite was not much affected; the bowels were regular, rather relaxed in warm weather. Coming from Nice to Paris he experienced very evil effects from the change of temperature: at the latter place he got severe general pains, particularly about the joints; these grew worse in the moist and cold weather at Paris and London, to which place he next came. Chloral did not relieve these pains at all except when it put him to sleep. They were peculiar in character, there was no tenderness anywhere, and no aggravation from movements.
On the day before I first saw him he made a mistake with his dose. Having been accustomed to make a dilute solution from a strong one which he kept ready, by some blunder he took a dose of the latter instead of the former. He slept during the day, but got up and went to dinner in the coffee-room of his hotel at 7.30 P.M. He had no sleep during the following night, and the pains came on with frightful severity. I was sent for the next day, and saw him about 6 P.M. Careful inquiry made it apparent that the dose which he had taken on the previous