THE type of case with indications for Bromium is that where there is suspicious ulceration in the stomach, usually with a history of pain coming on immediately after food, and very often of definite coffee-ground vomit. As a rule, these gastric pains are worse during the latter part of the day, and worse at night, and there are various gastric, or appetite, symptoms which are helpful in the selection of Bromium for these patients.For instance, they often have an acute desire for acids, although their pain, or discomfort, is markedly aggravated from taking acid foods; and the taking of acids will not infrequently produce a sudden violent diarrhoea, or an acute gastric irritation which sets up a very irritating cough.In other words, the stomach cough of our infancy does exist, and you meet it in these Bromium patients. They also have as marked an intolerance to oysters as you associate with Lycopodium.
Another point that sometimes helps to a Bromium diagnosis is that these patients have a undue susceptibility to tobacco. It is the common practice, when treating gastric or duodenal ulcers, to forbid tobacco, and in Bromium cases it is an absolute necessity, because they are extremely sensitive to it. They often say that smoking will produce gastric pain almost immediately; even sitting in a room where people are smoking is often enough to upset them.
They also get a marked aggravation from hot foods or hot drinks. These increase the discomfort or pain, make them feel sick, and may actually make them vomit; and yet they have a strong dislike for cold things. They get a sensation of hunger-an empty feeling in their stomachs-which is relieved by taking food, although their actual pain is aggravated. So you very often get an apparent contradiction.
So far as the general make-up is concerned, there are one or two points which help in Bromium selection. The patients are definitely hot-blooded. They are sensitive to heat, to hot rooms, to stuffy atmospheres, but they are even more sensitive to draughts, particularly a draught of cold air. If they exert themselves, they often suffer from distressing palpitation. They are usually somewhat emaciated, and not infrequently you have a history of recurring sore throats, and often their tonsillar glands will still be somewhat enlarged.
Bromium patients are always depressed, and have a strange kind of indifference. The one thing the Bromium patient does not want to do is work of any kind; he simply has no interest in it, and he shuns from it.
Although Bromium patients have a tendency to flush when they get hot, or when they are in a hot atmosphere, as a rule they are pale, rather an earthy colour; and they may be completely ashen in appearance if they have had much haemorrhage. And with their coffee-ground vomits they very often have a fairly sluggish, long-standing ulcer, and a history of repeated tarry stools.
Finally, these Bromium patients often complain of a very salt taste in the mouth, particularly in the morning on waking.