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minutes to a strong stream of carbonic acid, then mixed with starch-paste, and divided into two equal portions. To the one portion of test freshly prepared water containing protoplasm1 was added; to the other an equal quantity of ordinary water. In the first test, with a good arrangement of the experiment, the blue colour of iodide of starch was immediately developed, or showed itself within a few minutes. The indifferent protoplasm of the plant-cells had then, with the assistance of carbonic acid, set the iodine free. The acid alone did not suffice, as was to be expected beforehand.
The experiment succeeds still better if, instead of carbonic acid, we employ a very diluted mineral acid; preferably phosphoric acid. Here the acid acts on the circulating KI or NaI simultaneously with the active oxygen of the gland-protoplasm. The iodine is separated, either directly (according to the formula 2KI + CO2 + 01 = K2CO2 + 21) or, what comes to the same thing, after previous formation of iodide of hydrogen; and the free metalloid thus obtains the power to directly seize upon certain albuminoid bodies to which it has, in general, a great affinity. In this relation of the KI, (as the experiment shows us convincingly, and with the clearness of a schema) there may also lie an indication for the understanding of certain cures of tumours, of the everyday occurrence of which there is no longer the least doubt; the process of which, however, still belongs to the region of mystery. One can, indeed, on the ground of established facts, carry the hypothesis further, and say that there decidedly are certain specifically constructed groups of cells which easily decompose KI and are then affected, in their own existence, by the free metalloid.
My whole argument respecting the decomposition of KI rests on the assumption that in our tissues the oxygen is present as 01. At the present day this is an indisputable fact, on the proof of which I have expressed myself thoroughly in another place. Everywhere, when oxidations take place in warmblooded animals, this occurs by means of the so-called "active" oxygen (the ozone, O1 of Clausius). Even Hoppe-Seyler, who
1 Compare, on this point, my recent researches in Virchow's Archiv. vol. xlvi. p. 150.
2 Berliner Klin. Wochensch. 1872, No. 30.
formerly did not incline to this opinion, has very lately expressed himself in its favour.1 He maintains the existence of "ozone in the organs," and even admits the condensed molecule O,, which is not at all necessary to my hypothesis.
We can less easily entertain favourable ideas of a decomposition of KBr analogous to that which KI probably undergoes. If one carries out a similar research to the above (of course without the starch paste) one finds no trace of free bromine. We cannot be surprised at this. The combination of alkalies with bromine is much more stable than that with iodine. At low temperatures neither nitrous nor hyponitrous acid, nor the latter with some free nitric acid, sets bromine free from a diluted solution of KBr and similar salts, while all these agents are known to effect this easily with KI (only that HNO, if both it and the KI are pure, requires preliminary warming). We have, with these agents, often to do with nascent oxygen, qualitatively just as in the action of the protoplasm. Certainly, we cannot altogether deny the transient decomposition of KBr in the human organism, since we see that in the stomach glands hydrochloric acid is set free from chloride of sodium; which at any rate is an instance of equally powerful chemical change. But it is not likely that this decomposition endures, in the case of the officinal bromides: and the notion of Saison 2 that the breath smells of bromine after KBr has been taken, reminds one vividly of the fire-breathing monsters of antiquity.
The negative behaviour of KBr in the test-tube is thus seen to harmonise with the results of our earlier researches, and of the therapeutical observations of Sander and others. Modern bromo-therapy requires reformation if it is to be legitimised on a scientific basis, instead of being merely empirically accepted. The following questions press anew for investigation :—
1. What is the behaviour of NaBr and KCl in the numerous cases in which KBr is at present considered to be indicated?
2. Are the numerous successful results really to be attributed to KBr as a nervine, and not to the natural decline of the morbid processes, to psychical impressions (Amburger), or to an 1 Pflüger's Archiv. 1873, vii. p. 415.
2 Quoted by Nothnagel, Arzneimittellehre, p. 40.
improvement of nutrition by means of the potassium, and other factors which mislead observation ?
The simple assertion-that KBr or any other agent is of use in such and such cases-does no service to the progress of therapeutics. That is just what the homoeopathists say, with equal justification, when they cure abscesses with Silicea, croup with Spongia, insomnia with Calcarea-all, of course, in extravagant dilution-and it may be read in the works of Rademacher and his better followers, on every side, expressed with sincere conviction. What right, then, have we to abuse that system, when we blindly give ourselves over to similar logic? A therapy which aspires to free itself scientifically from systems of indistinct or incomplete testing must either bring forward long series of observations with corresponding series of check-experiments, or else the theoretical and experimental ground-work of those facts which it views as instances of cure. Whether and when the latter is the best method of testing a particular treatment, we know depends upon the solution of a number of preliminary questions: the former is open to every practitioner who has large and not too scattered materials at his command. And now, without wishing wholly to deny the justice of the prevailing bromo-therapy, it may be well expected, from the manifold contradictory facts, that of the many hundredweights of this salt which are now yearly expended, a few pounds will soon again be found sufficient for the purposes of scientific clinical medicine.
[The Editor has translated the above paper, with the author's consent and wish, from the Deutsche Klinik, a journal very little read in England. He has to apologise for some idiomatic defects in what has been a rather difficult bit of work.]
THE ENGLISH STAND-POINT RESPECTING THE
VALUE OF BROMIDE OF POTASSIUM,
BY DR. ANSTIE.
THE severely sceptical paper by Professor Binz which precedes this article will be read with surprise by most English medical men; but those who know the difficulties of therapeutical inquiry will probably feel that such criticisms have great value in forcing us to scrutinise our grounds of belief with additional rigour. We may certainly affirm that several of the positions which Dr. Binz signalises as dubious or false are in this country habitually taken as true. The best test of the matter is to inquire what is the general impression and practice among the eminent men who are, or have been, physicians to the National Hospital for the Paralysed and Epileptic, where thousands of epileptic patients are treated. Of these one may quote Dr. Reynolds, as a well-known author of standard works on epilepsy.1 Dr. Reynolds speaks of KBr as if it were the only remedy worth consideration in the direct treatment of simple epilepsy. He says: "It is to be demonstrated, in my opinion, that there is something 'specific' in the action of KBr. Potassium—given as iodide is without such effect; and bromine - given as bromide of ammonium-has no obvious influence on epilepsy; but in combination, these two elements-bromine and potassium
-are of undoubted value." And he sums up the general question as to epilepsy thus:-"(1) The cure of epilepsy is effected by doses varying, for the adult, from 5 to 40 gr., given three times daily. (2) It is not the mere administration of the drug, but its
1 See not only Dr. Reynolds's article "Epilepsy" in his "System of Medicine," vol. ii., but his article on KBr in the Practitioner for July 1868.
presence in certain quantity, that is necessary for a cure. (3) The dose which shall prove curative is not determined by either of the following conditions - sex, age, duration of disease, frequency of attack, severity of attack, or form of attack; but (4) Individual cases differ in some points, of which we know only this, that they are curable by different doses of bromide of potassium. (5) That when not curative it is of great value in diminishing the number of attacks; and that the dose in which it produces this effect varies between the limits I have mentioned. (6) That 'the number of cases in which it proves of no service at any dose is very small; and that the cases which resist its action do not differ in any other obvious respect from those in which the bromide is highly efficacious. (7) That bromide of potassium does no harm, even when given in the largest doses I have mentioned, for it may be taken for many months, and even for years, without producing derangement of any sort or in any direction. (8) That the rash, or acne on the skin, which is occasionally seen, is not determined by the quantity of bromide that is taken. I have seen it after a few doses, of 5 grains each, have been administered; and it has been absent in many cases where 30 grains have been taken, three times daily, for periods of 6 or even 12 months. I would therefore earnestly recommend that bromide of potassium should not be discontinued in the treatment of a case of epilepsy because of its apparent failure; but that the dose should be gradually increased, and the exhibition of the drug most patiently carried on for a period of many months or even years." Elsewhere Dr. Reynolds remarks that, while thus remarkably efficacious in epilepsia gravior, the bromide scarcely at all affects the attacks of petit mal, and is also less efficacious than usual where the convulsive attack only occurs at night. In regard to insomnia, this author mentions the sleeplessness of acute mania as sometimes, and that of delirium tremens as often, successfully combated by the bromide. He speaks, also, of paroxysmal (non-organic) vertigo not accompanied by obvious spasm, and paroxysmal headache with flushing of the face, as often rapidly relieved by it.
Dr. Reynolds's is probably the strongest positive opinion as to the value of KBr which has been published in this country; but