From The British Medical Journal.
BROMIDE is used chiefly in the treatment of epileptics, psychotics, and neurotics. A discussion of the treatment of epilepsy is outside the scope of this paper. With regard to patients in mental hospitals, it is the authors opinion that it is possible and preferable to use methods other than that of prescribing large doses of bromide to obtain the necessary relaxation and rest.
That bromide tends to be the regular “diet” of the neurotics was brought out very clearly by estimating the blood bromides of fifty consecutive admissions to the Maudsley Hospital– an analysis of these figures has been published elsewhere. It is difficult to escape the conclusion that in many cases bromides are given as a routine measure without any realization of the possible ill effects on the patient.
It is beyond dispute that a considerable number of “nervous” cases do benefit from taking bromide. It is difficult to delimit this group, but it probably comprises chiefly those in whom there is temporary increase in anxiety, and where there is reason to believe that outside events are playing a prominent part in causing it. Menopausal conditions and certain cases of sexual excitability also appear to be particularly helped my bromide, as are cases in which there is much irritability.
As a result of our investigations we have come to realize how little is known at present of the precise indications for bromide therapy and the best methods of employing it. We do not wish to appear to overstress its dangers nor to undervalue its use. However, within the last year three doctors have been admitted to the Maudsley Hospital suffering from bromide intoxication, none of whom had appreciated the true cause of their illness through ignorance of the cumulative effect of this drug.
This and other evidence suggests that throughout the country there are many similar cases being overlooked, resulting in a preventable quota of admissions to mental hospitals and much chronic ill- health.
Soon after the publication of the foregoing article, the following striking letter to the Editor, written by Dr. T. Robertson, of Glasgow, appeared in The British Medical Journal:.
SIR,– The admirable article on bromide intoxication in the Journal of November 14th does not seem to have been comprehended as to the full implication of its facts and theories; and whether to congratulate the authors of this paper on their hard hood or their clinical acumen is a fine point.
The first and most obvious conclusion is that doctors do not know their business. Now medical men spend much time and trouble in learning a materia medica whereby they are supposed to acquire such a knowledge is improbable from the very nature of their academic studies and impossible under the conditions of clinical experience. It is true that they know a great deal about the actions of single drugs upon cats, mice, frogs, monkeys, gorillas, ducks; and how these drugs act upon lacerated portions of the anatomies of these unfortunate creatures.
But when it comes to determining or knowing about the action of drugs upon men, whom doctors are supposed to treat and understand best, we find that the medical profession knows its business so badly that it takes the united efforts of three of them to point out to the remainder an elementary error which they habitually and universally practise!.
I have said that doctors are ignorant of the true action of drugs upon the human body and do not know their business. Let me hasten to make a qualifying admission on this point. I have before me several works on materia medica, and especially one entitled Allens Encyclopaedia of Pure Materia Medica. This noble, if almost unknown, work shows 1877 as the year or publication, but it should be borne in mind that much of its material was gathered long before that date, and, indeed, the main facts might safely be reckoned as one hundred years old.
It will at once be obvious to readers that such a monument of pre- scientific thought is not likely to hold much interest for them. Turn, however, to the article on Kali bromatum, and there it will be found that this drug, when administered to human beings (names, dates, and place being duly supplied) caused, inter alia, the following symptoms to be observed:.
Memory absolutely destroyed– amnesic aphasia– words repeated or misplaced — mentally dull– answers slowly– fearful apprehensive mood– hallucinations of sight and sound– with or without mania — delirium– with delusions– weeping and profound melancholia– cannot recognize persons— slow speech — staggers as if drunk–stupor–fainting— drowsiness–coma– dilated pupils–eyeballs moving in all directions and not taking notice–vision dim–squint–anaesthesis of throat, mouth, and pharynx–pulse imperceptible, feeble, or intermitting–action of heart slow and fluttering –incoordination of muscles–paralysis of motion–skin eruptions of all varieties–sleepiness–sleeplessness– and so on, with an account of symptoms running into several pages and verifying in every particular the symptomatology described in the paper on “Bromide Intoxication.”
If, as we are told, 5,000,000 insured persons receive bromides in a year in Great Britain it follows that of the total population some 15,000,000 (or about one-third) receive this dangerous drug in the same period, and at that from the hands of a body of professional men who know so little about the dangers of their job that they have even now to be instructed anew about facts discovered one hundred years ago. In the face of such ignorance, is it to be wondered that the Maudsley Hospital in one year admitted three medical men so poisoned that they were not only seriously ill, but in grave danger of being certified as insane?.
The statement that bromides are responsible for a preventable quota of admissions to mental hospitals and much chronic ill- health is damning enough against our profession; but when we consider that not only bromides, but many other drugs can, and do, lead to chronic ill-health also, the situation becomes deplorable. Drs. Barbour, Pilkington, and Sargant have shown the dangerous symptomatology resulting from the prolonged administration of bromides. This identical symptomatology exists in Allens Materia Medica, and there is therefore so much reason to believe that this latter author is trustworthy.
But when we turn up in Allen the symptomatology of the administration of iron, opium, arsenic, nux vomica, phosphorus, bismuth, iodine, iodides, sodium bicarbonate, magnesia, alumina, sulphur,. belladonna, and many others which are in regular and prolonged use by physicians, we find innumerable pages of grisly facts showing that the use of these drugs is also followed by symptoms in all respects as alarming as these caused by bromides. If Allen is correct — and clinical experience shows that he is — the medical profession is only now beginning to understand the enormity of administering drugs in crude doses to the human body.
Drug symptoms are the commonest result of the administration of medicines in this way, and physicians would do well to read Allens Materia Medica and apply its drug pictures on the simple, effective, and at all times non-poisonous principles as laid down by Samuel Hahnemann.