Any ammoniacal preparation will be useful, and I have seen good effects produced by the bicarbonate, by sal-volatile, and also by acetate of ammonia, in doses smaller than those required to produce diaphoresis. But the muriate is by far the most effective preparation; and, indeed, I have seen several instances in which two or three doses of twenty grains, given at intervals of four hours, have produced a decided change, and a marked recommencement of biliary excretion.

A much more doubtful matter, as to which, nevertheless, I am not prepared even to lean with any strength towards the negative, is the reputed emmenagogue influence of muriate of ammonia. There are probably very few physicians educated in the ideas of recent therapeutics, who believe in anything like specific emmenagogues-that is to say, in remedies which in all circumstances, exert a more or less powerful and direct influence in the direction of provoking the menstrual flow. And although there are probably as few practical physicians who do not believe that there are several medicines which, given under exactly the proper and favourable circumstances, do appreciably assist the function in question, yet it cannot be disputed that there is always immense difficulty in deciding the exact degree in which this action has been curbed in any particular instance. It is abundantly clear that such remedies as iron only act by improving the quality of the blood and the general tone of the nervous system, and it is extremely doubtful if such medicines as aloes, either alone or in combination with iron, have any more than this effect, with perhaps the added advantage, in particular cases, of keeping the intestines unloaded, and thus removing a source of frequent nechanical pressure. Of ergot of rye, and one or two remedies physiologically allied to it, it seems as if we were justified in speaking rather more strongly; and it remains doubtful, as far as my experience goes, whether muriate of ammonia may not ultimately prove also to possess a real influer ce upon the pelvic sympathetic nerves, which approximates its effects to those of the former drug in this particular direction. Given in ten-grain doses thrice daily, in cases of amenorrhoea marked rather by general feebleness than by anything like anæmia, it has occasionally seemed to me to conduce directly and considerably towards the cure. But of this, as of all other emmenagogues, it is pre-eminently true that they are worth absolutely nothing unless used precisely at the fit occasion.

In concluding this paper we may remark that there is not one fact mentioned in it that does not point to the nervous system as the locus in quo of the therapeutic action of the muriate of ammonia. The relief it affords in myalgia, or in suppressed secretion, is surely as directly nervous as its anodyne effect in pure nerve-pain. It appears, in fact, when given in therapeutic

doses, to be a pure tonic stimulant to sensitive nerves, raising them to a level of tense vitality too high for the explosive perturbations which, when carried to the brain, are translated as pain, and to the vaso-motor system, directly inciting to a superior tone of the systemic vessels, which puts an end to that exaggerated passive congestion of viscera which is known to be fatal to the healthy performance of the function of secretion.Practitioner, Dec. 1868, p. 357.

16.-ON THE USE OF THE BROMIDE OF POTASSIUM IN THE TREATMENT OF SOME NERVOUS AFFECTIONS.

By Dr. JAMES TURNBULL, Physician to the Liverpool Royal

Infirmary.

[A most singular and interesting discovery has been recently made with regard to the therapeutical action of some of the vegetable alkaloids. It is found that by altering their constitution, so that they are changed from nitrile to ammonium bases, their actions are so completely changed that we might say they are reversed.]

The experimental researches of Dr. A. Crum Brown and Dr. Thos. R. Fraser have now actually proved what was here anticipated in 1854, and have demonstrated that certain properties are common to members of a series; for, by converting strychnia, brucia, thebaia, codeia, morphia, and nicotia, which are nitrile bases, into ammonium bases, by the addition of iodide of methyl, they not only reduce the poisonous properties of these alkaloids, rendering them comparatively innocuous, but they entirely change their action on the nervous system; so that, whereas several of the nitrile bases, more particularly strychnia, cause violent spasmodic muscular contraction, the ammonium bases,—for example, the iodide of methyl strychnium,-paralyse the spinal motor nerves, and cause muscular relaxation. "We may conclude," they observe, "from these facts, that, when a nitrile base possesses a strychnia-like action, the salts of the corresponding ammonium bases have an action identical with that of curare. ""

This is not only a most important discovery, but it shows what great results in the elucidation of the modus operandi of medicinal agents may be expected from well directed enquiries, aided by the light which the present advanced state of organic chemistry can throw on the subject.

[Passing on to the therapeutical uses of bromide of potassium the writer observes:]

The therapeutical use of the bromide of potassium, which I

wish more particularly to notice, is the power which it has of producing sleep when adininistered in full doses. There is no medical man in extensive practice who has not in various cases experienced much difficulty in overcoming the troublesome symptom of sleeplessness, and felt the want of an efficient remedy in cases where opium could not be used. Though opium is one of the most valuable remedies in the Materia Medica, we all know from experience that it often causes increased restlessness instead of sleep, and produces various consequences, such as constipation, headache, &c., which render it altogether inadmissible with some patients. Though morphia is less liable to produce such unpleasant consequences, it is not free from these objections; and the various other derivatives from opium which have from time to time been brought into notice, such as the sedative solution of opium, chlorodyne, nepenthe, &c., are none of them entirely free from the objectionable effects of the parent drug.

When sleep is prevented by pain, arising from some abnormal physical condition of the body, opium in some of its various forms is the grand remedy; and, if we except chloroform, it has no rival as a sleep-inducing agent in this class of cases, but there are others where the want of sleep arises from mental rather than from physical pain, or from trifling causes exciting a morbidly sensitive nervous system. In the latter, opium often prevents, instead of inducing sleep, and causes its after effects in an aggravated degree. I have tested the bromide of potassium in some cases of the latter description and being convinced that it is a remedy of power, and one the value of which is scarcely yet generally known by medical men, I shall briefly give some details of a few cases of this description in which I have used it with advantage.

Brown-Sequard was, I believe, the first to point out the value of the bromide of potassium in inducing sleep, and to show the mode of giving it, and the kind of cases in which it is most likely to prove of service. In one of his lectures on the recent advances of our knowledge in the diagnosis and treatment of functional nervous affections, he says, "It is of the utmost importance to improve the sleep, which is generally bad in persons attacked with a morbid increase of the reflex excitability. For this purpose an invaluable remedy has recently been discovered; it is the bromide of potassium. Except when pain is one of the causes preventing sleep (in which case opium, aconite, and belladonna should be employed together), I have found that this remedy has a wonderful power to produce quiet and refreshing sleep, without any drawback that I am aware of. ' I usually give to adults a dose of thirty grains of that salt a quarter of an hour before the last meal, and a second dose of

from thirty to fifty at bedtime. In cases in which, without any nervous complaint, there is sleeplessness, owing to some cause of cerebral excitement, as well as in all neuroses, excepting hydrophobia, tetanus, very severe cases of delirium tremens, and some forms of insanity, sleep is almost always induced by that remedy."

Dr. Behrend has published in the Lancet some cases in which he gave the remedy with great advantage. It was, however, from reading Brown-Sequard's lecture that I was first induced to make trial of it, and I shall now refer to some of the cases in which I have given it.

Case 2.-I frequently attend a gentleman, about 68 years of age, of nervous temperament, who has for many years had slight facial paralysis, and who had about ten years ago, and subsequent to the facial attack, a very severe nervous attack, with some head symptoms. He suffers habitually from constipation, and at times from dyspepsia, with flatulent painful sensations at the stomach, which often deprive him of sleep for many successive nights. In this case I have found that nothing affords so much relief as the bromide of potassium, which he takes when troubled with these symptoms in half-drachm doses, one about seven o'clock in the evening, and again at bedtime, with the effect of inducing sleep without the least unpleasant consequence.

The three next are cases of delirium tremens, and in the first of them opium had been freely tried without success, but sleep was readily induced by the bromide, given in half-drachm doses every four hours until two drachms had been taken. The second was a very violent case, where the remedy was administered in the same way, until seven drachms had been taken, but, with each of the last half-drachm doses of the bromide, a pill with one grain of opium was likewise given. After that, sound sleep was induced; and the symptoms rapidly abated. The third was a milder incipient case, where the bromide alone in moderate quantity sufficed to calm the nervous excitement and induce sleep.

Case 3.-The patient was a gentleman about 34 years of age, of dissipated habits, who had several times suffered from delirium tremens. I saw him, in consultation with Mr. Byerley, who had given opium largely without effect. The symptoms were like those of typhoid delirium; there was profuse perspiration, and the pulse was very weak and rapid. He had picking of the bed-clothes, and was quite unable to understand or reply correctly to questions. We ordered half a drachm of the bromide of potassium to be taken every four hours till he slept. After the fourth dose, which was taken about two o'clock in the morning, he fell asleep, and slept for five hours. He awoke

quite conscious, and when I saw him about midday all the symptoms were better, and he soon got quite well.

Case 4.-I was summoned to see, in consultation, a gentleman about 38 years of age, who had on several occasions suffered from attacks of nervous excitement, his habits having been intemperate for several years. He had the usual symptomsrestlessness, tremor, profuse clammy perspirations, and no sleep for three nights. He was quite delirious, and saw imaginary objects, but talked rationally for a few seconds, and then wandered quite incoherently. The pulse was very weak (94), and the hands very unsteady. He had been freely purged, and I at once prescribed half-drachm doses of the bromide, with aromatic spirit of ammonia, every four hours, the alcoholic stimulant being limited to six glasses of sherry, which, however, he overstepped. The following day he was still incoherent, but less excited, and more manageable. As he had not slept, the bromide was continued, and he was ordered to have with each dose one grain of opium. The next morning he went to sleep at half-past six, and slept soundly for four hours. He awoke at intervals during the day to take food, but no further sedative was needed, as he became perfectly quiet and rational; and, having slept the third night, he was quite convalescent on the fourth day from my first visit.

Case 5.-A gentleman, 33 years of age, a wine and spirit merchant, of nervous temperament, and rather irritable digestive organs, came under my care, suffering from vomiting. He was tremulous, perspiring, and had the frightened look of one who was suffering from over stimulation, though from constant tasting, rather than habits of intemperance. He had no delirium, but had suffered from restless, sleepless nights, as well as the vomiting. Having purged him with podophillum and aloes, I gave him fifteen grains of bromide of potassium, with aromatic spirit of ammonia, three times a day, and half a drachm of the bromide at bedtime. This treatment soothed the nervous excitement, and produced sleep, and in a few days he got quite well.

tom.

Case 6. In the first number of this journal, I published the case of a woman, 26 years of age, who had hemiplegia, preceded by convulsions, and where sleeplessness was a prominent sympShe was most urgent in asking for something to make her sleep, not having slept at all for many nights, and being greatly exhausted by want of rest. Fifteen grains of the bromide were ordered to be taken at six in the evening, and again at nine o'clock. She slept the first night, and after taking it in this way for a few days, there was no further need of the remedy. She also recovered completely from the paralysis of the side.