Kali Bromatum - General symptoms - T.F. Allen

GENERAL

General

Decidedly insane. had delusions that lewd women had got into his mother's house.

that he was pursued by the police.

that his life was threatened by members of the family.

that he had thousands of dollars in Aurum Metallicum ^gold sewed up in his clothing, etc.

his appearance and manner were very similar to those of a drunken man, except that his face was exceedingly pale.

his pulse, which was normally about 80, and fallen to 60.

skin cool. pupils contracted.

his manner was excited and rambling, and his hands constantly busy, either in fumbling in his pockets, tying his shoes, picking threads from his clothing, or in searching for the Aurum Metallicum ^gold which he believed was concealed in the lining of his coat.

his character also had undergone a radical change, from having been very frank and brave, he had become excessively timid, and suspicious of every trifling circumstance.

it was ascertained that he had secreted large quantities of the Bromide in various out of the way places about the house.

several times he attempted to throw himself from a window, and battered down a door with an axe, in order to escape from some imaginary danger.

he was removed to a lunatic asylum, where the symptoms gradually disappeared, and in a month he returned to his home well,.

He imagined that he had been especially singled out for divine vengeance, and he spent the greater part of the evening in loudly deploring his sad fate, falling suddenly asleep at intervals of a few minutes.

towards 12 o'clock he became quiet, and passed the rest of the night in a sound sleep (first day).

he was walking his room, groaning and wringing his hands.

he informed me that he had been accused of robbing a friend, and that the officers were in search of him (second day).

slept from about 6 P.M. till 5 A.M., when he was quiet, composed, and altogether in his right mind (third morning),.

She had the erroneous idea that she was deserted by all her friends, and as consequence she passed all her waking moments, which were not many, in tears.

another delusion, that her child was dead, had taken fixed possession of her mind.

she declared that she saw it dead before her, and when it was brought to her, she refused to acknowledge that it was hers, or had any resemblance to the one she imagined was dead (eighth day),.

Very soon she began to manifest symptoms of melancholy, attended with delusions.

she was taken to Long Branch, and while there continued to be insane.

she fancied that the boarders in the hotel insulted her, and imagined that the weekly bills of the landlord were evidences of a conspiracy which had been got up against her father.

on the way up from Long Branch to this city, while standing on the guards of the boat, she suddenly gave a loud shriek, and declared she had seen her brother fall overboard.

the administration of the Bromide was stopped, and in a few days her mind became sane, and has since remained so.

throughout the whole progress of this case, there was profound depression of spirits, and all her delusions were of a melancholy character,.

Depression of mind, during which he experienced the most gloomy ideas relative to his present and future condition, if an opinion could be formed from the signs of distress, such as weeping, moaning, and wringing his hands, which he continued to manifest.

two hours after this he fell asleep, and when he awoke eight hours afterwards was perfectly sane (fourth day),.

Enfeebling of mental power.

a little page in my accounts, which I should usually have prepared and balanced in half an hour, took me two or three evenings' work.

but the worst tendency was to talk "Mrs. Malaprop" English, substituting one word ending in "tion" for another in a most provoking and yet ludicrous way.

I had once to write some letters reminding people that their subscriptions were due, and I had the misfortune of having my letters (I think one or two of them) brought back to me by the clerk, who pointed out to me that I had written "contraction" or some such word instead of "subscription,".

*Loss of memory to such an extent that he forgot how to talk.

for instance, when asked why he took so large a dose, he was fully two minutes endeavoring to frame a reply, and was then obliged to give up the attempt with the remark, "I can't;" in fact, *there was well-marked amnesic aphasia, for there was no difficulty in co-ordinating the movement of the tongue so as to articulate distinctly any word he was told to pronounce (fourth day),.

In some individuals the memory is oddly affected.

*single words are forgotten, or one syllable is constantly dropped out of a work, whenever that word is spoken by the patient, or two words are invariably interchanged.

thus, a lady, twenty-eight or thirty years of age, suffering from chronic ovarian disease.

to whom I gave about 12 grains three times a day, making a continued daily dose of nearly 40 grains of the Bromide of potassium, began, after she had taken it two or three weeks, to exchange two words for each other.

she called a Fagopyrum ^buckwheat cake a comb, and a comb a Fagopyrum ^buckwheat cake.

at the hour of her morning toilet she would direct her maid to bring her a Fagopyrum ^buckwheat cake and arrange her hair.

at breakfast, if there were Fagopyrum ^buckwheat cakes on the table, she asked for a comb to eat.

once during the existence of this peculiarity, I undertook to convince her that she had transposed these words, and that a comb was a spoken sign of a comb and not of a cake.

the effort was unsuccessful.

she never transposed or confused the ideas of cake and comb, only the words or signs,.

On attempting to stand up, and especially to walk, there is a peculiar vertigo, characterized by a sensation of emptiness around one, and under one's feet, so that one is afraid to move.

it seems as if the ground gave way, and the sense of resistance was lost.

the gait is staggering, and at last walking becomes almost impossible, or, at least, one feels obliged to give it up (after one and two hours),.

The results of the smaller doses were not altogether uniform.

a certain degree of congestion appeared, however, to be produced. With half drachm and drachm doses, and once with a scruple dose, the disk and retina were congested even in ten minutes after administration and this state of congestion went on increasing, as long as examinations were made.

even after the lapse of several hours, the increased redness was still manifest.

the vascularity was found to be greater as the dose was increased. The exceptional phenomena were, in one case, a brighter redness of the vessels after ten grains. In another case, a hazy condition of the vessels was noted, after a scruple dose,.

According to Voisin, the local anaesthesia of the pharynx does not appear after a less dose than 30 grains.

it is not always produced by this dose.

but if two or three such doses are given several hours apart, there will be impaired sensibility of the pharynx for several hours after the last dose.

consequently, a continued daily dose of above half a drachm generally affects the sensibility of the pharynx in proportion to the amount taken above that quantity.

but only one part or kind of the sensibility of the pharyngeal mucous membrane is impaired or abolished. "We should distinguish," says a late writer, "two kinds of sensibility in the region of the veil of the palate, a functional sensibility and an ordinary sensibility.

the ordinary sensibility varies with different individuals.

but it is not the measure of the functional sensibility.

the latter varies but little.

this functional, sensibility is the same as the sensibility of the intestine.

and like the latter, it depends, according to M. Claude Bernard, upon a ganglion, the spheno-palatine.

it has its special mode of irritation, which is neither pricking nor burning, but the lightest contact.

if the touching even exceeds the physiological limit, vomiting is produced.

bromide causes this to disappear at once.

movements of deglutition remain intact in bromized individuals, and are not performed with less energy than previous to the treatment.

when, by titillation of the uvula, no effort of deglutition or vomiting is induced, it is apparent either that the pharynx and palate no longer conduct the tactile impression, or that this impression is no reflected.

as the reflex power of the cord has lost none of its energy, and there is no want of precision of movement, we must admit that the periphery alone is affected,".

The acidity of the urine was usually increased.

the coloring matters were invariably increased.

the urea was not affected.

the Acid Phos ^{phosphoric acid} varied.

by small doses it was increased.

the chlorides always and notably increased.

save when the bromide was acting as a poison.

this chloride leaving the body was chloride of potassium.

the figures of the three experiments were an average of 22.56 grammes of chloride of Argentum Metallicum ^silver in twenty-four hours on the days preceding the exhibition of Bromium ^bromine, and 24.29 on those days when that salt was taken. Analysis showed in some of these cases the amount of potash in the urine increased from (estimated as chloride) 2.5 to 12.80 grammes,.

Discharge of urine both frequent and more copious (eleventh day), also in the preceding night.

in the evening of the eleventh day about half a pint of urine passed every half hour for several hours.

the urine was pale of high specific gravity, loaded with what appeared to be phosphates, of which a cloud was passed with the urine.

the minute crystals could be plainly seen when held up to the light in a beaker-glass.

on standing for a few minutes the sediment filled one-quarter of the space occupied by the liquid.

heating the urine precipitated the phosphates in a white cloudy sediment.

addition of Nitric Acid ^{nitric acid} immediately dissolved it,.

GENERAL SYMPTOMS.

Objective.

An increase of destructive, without a corresponding increase of constructive metamorphosis, and consequent emaciation (after continued doses),

Diminishes the retrograde metamorphosis of tissue,

Diminution of mucous secretions generally,

The capillary circulation is materially affected, not only of the nervous centres, but of the whole system; this, however, is independent of the heart and large arteries,

Emaciation (after long-continued use),

General emaciation,

Considerable emaciation,

Great emaciation,

Very emaciated and weak, and of a peculiar pallid color,

Marasmus and emaciation, which endanger the life, may set in after too long-continued use,

Among the symptoms caused by the drug there are some which have escaped the notice of previous observers, but which, if not recognized, might lead to serious mistakes in diagnosis. I refer to cerebro-spinal affections _ characterized by general delirium, hallucinations, fancies, about being persecuted, violent actions, ataxia of the limbs and of the tongue, and impeded articulation _ which might be taken as indications of general paralysis. All these alarming symptoms disappear on leaving off the medicine,

Better than usual, less tired, with more ability and inclination to walk than previously (while taking the drug),

Sedation,

Averse to exercise; sits and lounges about,

Invariably sat crouched up by the fireside all day, evidently devoid of all energy and resolution,

Disinclined to talk, read, or study, to walk or work; quite indifferent to many objective annoyances that commonly irritated him; in fact, superlatively lazy, indifferent, and sleepy, yet by a strong effort of will able to converse, study, compose, walk, work, and fret as well as ever,

Languor of movements,

Great languor,

Unusually quiet, sitting languidly on a chair; he could not collect his thoughts to answer a question properly,

Lassitude (soon),

Weakness,

Weakness of the muscular system,

So extreme a degree of weakness that the medicine had to be stopped,

Great feebleness, physical and mental, after disappearance of the symptoms,

General debility,

Great muscular debility,

Considerable prostration, compelling him to lie down (after one hour),

Great bodily prostration,

Extreme general prostration,

Inability to walk or stand,

Inability to hold herself upright,

Unable to move or feel,

After a time he is obliged to keep his bed,

Extremely adynamic condition,

Lies quietly, unable to move, feel, swallow, or speak (after a toxic dose),

There is a class of phenomena dependent on the Bromium ^bromine _ cachexia, which must be accurately distinguished _ viz., those due to the adynamic character liable to be assumed by acute maladies which may attack an epileptic patient during the administration of the drug. Thus, a pneumonia, an enteritis, a rheumatic seizure, or a simple boil may be accompanied by such a debility of the vital powers as shall rapidly determine a fatal issue,

Fainting,

Muscular weakness becomes complete paralysis (after a toxic dose),

Remarkable degree of restlessness and fitfulness of motion, as a consequence of the giddiness or intoxication, the patients being sometimes unable to keep themselves on their feet,

Subjective.

Diminished nervous sensibility in general, and especially diminution of reflex sensibility,

Mental and physical lassitude, indisposition to effort, and indifference to all slight causes of nervous irritation.

the crying of children in the house, the rattling of carriages on the pavement, the irritation of worrying or anxious thoughts, all are disregarded.

the sweet carelessness of doing nothing, the Neapolitan's dolce far niente is almost realized.

this state is soon succeeded by drowsiness, and drowsiness by sleep (after 20 or 30 grains),.

During the whole period of the action, and even during its decline, there is experienced a profound dulness of tactile sensibility in all its forms, but especially in those which are concerned in reflex manifestations. Thus, tickling of the feet is scarcely felt, and no longer produces its usual effects.

cutaneous sensibility, when tested by pinching, is found to be diminished.

the perception of touch by the hand is so modified that prehensile movements are deprived of precision,.