Bromium

Lecture XLVIII — Halogens — Bromine and Iodine; and Spongia

Halogens.

-J I Highly irritant to the mucous membranes.

Spasm of the glottis.

Pseudo-membranes.

I Glands, etc.

Halogens. < Bromine. -I Phos., Ant. tart.

Carbo an.

Aeon., Spong., Hep., Kaol.

Kali brom. >Amon. c.

Fluorine.

f Merc, Phos., Sulph., Calc. ostr.

| >Sulph.

Iodine. -{ Ars., Calc, Arg. n.

Spong., Hep., Kaolin.

[ Ant. tart.

>Starch.

>Hepar.

>Arsen.

Chlorine.

To-day we begin the study of the chemical elements termed halogens; Iodine, Bromine, Fluorine and Chlorine are the elements in this group. As a group the halogens may be remembered by this great characteristic symptom, they all act upon the larynx and bronchial tubes, and in fact upon mucous membranes generally. They are decidedly irritating to the mucous membranes, producing violent inflammation, rawness and excoriation, as anybody can testify who has once inhaled the fumes of Chlorine, Iodine or Bromine. They all produce spasms of the glottis and this is most marked in Chlorine, although they all have it. They all tend to produce pseudo-membranous formations on the mucous membranes. All excepting Chlorine tend to produce croupous membranes; Chlorine tends more to diphtheritic than pure croupous membrane. All of the halogens act upon the glandular system, producing enlargement, induration and even abscess in glands. Thus we find them all useful in scrofulosis, especially Iodine, which leads the list. Cyanogen also belongs to this group chemically, although it is properly considered as belonging to organic chemistry. It has many similarities to these drugs, and, like Chlorine, is useful in diphtheritic deposits. Thus we use Hydrocyanic acid and Amygdala Perska (which contains Hydrocyanic acid) for diphtheritic sore-throat, and we may use the Cyanide of Mercury, for some of the worst forms of diphtheria. The same is true to a less degree of Cyanide of Potassium. These general characteristics of the halogens lead you at times to say: "This patient needs one of the halogens, which shall it be?" To answer that question we must study these four elements separately and by comparison.

Bromine.

I will first call your attention to Bromine. Bromine produces a rather peculiar effect on the sensorium, causing a sort of vertigo, which is worse from running water. Anything moving rapidly produces this vertigo. It is associated with a peculiar anxious state of mind. Now this anxiety belongs to all of the halogens. It hardly originates in the mind, probably coming from some defect in the body, itself. It is a common symptom in heart and lung affections, and it is probably thence that the symptom springs. This anxiety is expressed in this way: the patient expects to see objects jumping about or he feels as if on turning his head he must see something or some one. This is an effect of Bromine, and those of you who are familiar with Bromide of Potassium will recognize whence it gets its anxiety. The vertigo is relieved by nose-bleed, showing at once that it is congestive in character. Another symptom indicative of congestion under Bromine is this: after dinner there is sensation deep in the brain as though a fit of apoplexy were impending. The patient feels as if he would lose his senses.

The Iodine mental condition is more marked than that of Bromine. It is a decided erethism, during which the patient is very excitable and restless, moving about from place to place, now sitting here, now sitting there; he fears that every little occurrence will end seriously. In his anxiety he shuns every one, even his doctor. He has a great dread of people. At times he becomes quite excited and delirious, with vertigo, red face and anxiety. In children with tabes mesenterica here is a characteristic irritability, screaming when looked at. Next, the lymphatic system. Like all the other members of this group, Bromine attacks the glands and causes enlargement and induration of the glands. Hence it is called for in scrofulosis. It is particularly suited to scrofulous patients, children usualh , when the parotid gland or glands are indurated, when there is a tendency to suppuration, with excoriating discharge, persistent hardness of the gland around the opening, and undue amount of warmth or heat in the gland. I have merely mentioned the parotid gland for purpose of illustration. Bromine also affects the mammary gland, for cancer of which it has been a very useful remedy. You may perhaps remember that I told you the other day that it was similar to Carbo animalis. Like Carbo animalis, it has induration of the glands in the axilla with burning pains. But 'Bromhie also has cutting pains. The breast is hard and on palpation, a dull subdued sort of throbbing may be felt in it. Sometimes the drawing or cutting is so marked that it feels as if a string were pulling from the gland into the axilla, a symptom more often calling for Croton tiglium or Paris quad.

The testicles are acted upon by Bromine. We find them swollen, hard and perfectly smooth and unduly hot. The pain is worse from jarring. You will find that glandular affections yield to Bromine, especially in persons of light complexion, with fair skin and light blue eyes. I mention this symptom here to make use of it in a few moments as a symptom of comparative value. I do not mean to say that every scrofulous child with blue eyes must have Bromine, but I do mean that this symptom is of use to enable us to distinguish

Bromine from the other halogens.

The tonsils, too, are affected in Bromine. Thus we find them deep red and swollen and covered with a network of dilated bloodvessels. They are worse when swallowing, and are accompanied usually with swelling of the glands externally. There is a feeling of rawness in the throat with this tonsillitis. This, too, as you know, is common enough in scrofulous children. Many have a strong temptation to excise the tonsils, but this is not good practice, for you can often cure this trouble by internal medication. In some cases, this enlargement of the tonsils may be looked upon as a forerunner of tuberculosis. We find Bromine indicated in enlargement of another gland, namely the thyroid gland, and curing what has been termed bronchocele or goitre.

We next have to speak of Bromine in its action on mucous membranes. Beginning with the nose, we find that it is useful in coryza or in nasal catarrh, when the discharge is profuse, watery and excoriating. The nostrils, alternately, seem to be stopped up. There is peculiar headache associated with this coryza, a heavy pressure in the forehead which seems to be pushing the brain down and out at the root of the nose. The nose is very sore inside and also around the alae. This is a smarting soreness, just such as you would expect the fumes of Bromine to cause. Later, ulcers form in the nose, with the escape of crusts or scabs, which are blown out and which are always blood} . Every attempt to blow the nose is followed by a discharge of crusts and blood. This you know is common enough with scrofulous children.

Coming now to the throat and lungs, we find Bromine indicated in spasm of the glottis, sometimes called laryngismus stridulus. This is a very difficult disease to cure. It is often central in its origin. It commences by sudden closure of the glottis. The child turns blue in the face, and its body becomes convulsed. One spell ceases only to be followed by another. In the second stage, general convulsions appear, followed by emaciation. The trouble may be reflex from dentition, or from indigestion, or from enlargement of the thymus gland. If it can be found to be the result of enlargement of the thymus gland, then^ Iodine is clearly indicated. When it has been caused by retarded dentition, I think that Calcarea phosphorica promises better than anything else. Dr. Dunham records a case that had been given up by an allopathic physician, but, knowing the symptoms of Chlorine, which, above all other remedies, will produce this spasm of the glottis, he generated some Chlorine, and allowed the child to inhale the fumes, with almost instantaneous relief and final cure. All the halogens are useful in this condition, but Chlorine is here the best of them all. Their symptoms differ but little so far as the local symptoms are concerned. We may also think of Sambucus, Antimonium tartaricum, Belladonna, Lachesis, Arsenicum and, in some cases, Phosphorus.

Lachesis is particularly indicated when the patient awakens from sleep with it.

Ignatia, whenever a cross word or correcting the child brings on the spasm.

Another remedy is Cuprum, especially when the spasms are general and the child clenches its thumbs.

Ipecacuanha may be of some use in some cases, but I have no confidence in it.

Nor have I in Sambucus, because, under Sambucus, I think the trouble is more in the chest, whereas, with Cuprum, the halogens, Calcarea phos., Lachesis and Belladonna, the trouble is in the larynx itself.

This spasm of the glottis often comes in the course of croup, in which disease Bromine may be the remedy when inspiration seems to be exceedingly difficult; the child is suddenly aroused from sleep as if choking. These symptoms are relieved by a drink of water, which seems to quiet the spasmodic condition. In membranous croup Bromine is indicated by the following symptoms in addition to the spasm already referred to: the child has at first a deep, rough voice, which, in the evening, amounts almost to aphonia. It cries with a hoarse, husky voice. The membrane seems to come up from the larynx into the throat. Every inspiration provokes cough, especially every deep inspiration. Breathing is hoarse, rasping and whistling, as though the child were breathing through a sponge or through some loose metallic substance which is vibrating. This is caused by the vibration of membrane as it is deposited more or less uniformly over the interior of the larynx. Later, there is rattling in the larynx. When the child coughs it seems as if the larynx were full of the loose rnucus. Antimonium tartaricum is very similar to Bromine in croup. It has rattling and wheezing, extending down the trachea as well as in the larynx.

Now, I wish to say a few words about other remedies in connection with croup, especially concerning Aconite, Hepar, Spongia and Kaolin. Kaolin is a kind of porcelain-clay, a combination of lime and silica, and has proved very useful in membranous croup. The relation which these remedies hold is this: Aconite is useful in the beginning of croup, whether spasmodic, catarrhal or membranous. It is indicated by the child suddenly arousing from sleep as if it were smothering. There is great restlessness. The skin is hot. There must be some anxiety present. Breathing is dry. There is no sound of mucus. Soon the child seems better and falls asleep, only to be aroused again. Arnica is especial^ indicated in these cases if the symptoms have followed exposure to drjr, cold winds. Do not stop your remedy too soon. If you do, while the child will be better in the morning, the symptoms may return with renewed violence the next night, and, before you know it, the mucous membrane of the larynx and trachea will take on fibrinous exudation and you lose your patient.

You will need to change to Spongia when you have these symptoms present: breathing during inspiration is hard.and harsh, as though the child was breathing through a sponge. The cough has a decidedly hard, barking, ringing sound. As yet the sputum is scanty. Spongia follows Aconite, especially after exposure to dry, cold winds, and in light-complexioned children with blue eyes. The symptoms are usually worse before midnight. Suppose this fails you, then you may have recourse to Hepar sulpharis calcarea.

Hepar usually is worse after midnight and towards morning. The cough has the same harsh, croupy sound, but there is a great deal of moisture with it. This is the indication for Hepar. It, too, is worse from exposure to dry, cold winds. Sometimes all these drugs fail, and we have to resort to the halogens, especially to Bromine and Iodine. I have already given you the symptoms of Bromine; let me tell you how to distinguish it from Iodine. Iodine is particularly indicated after the failure of Hepar, when the membrane has formed; inspiration is exceedingly difficult, both from spasms of the throat and occlusion of the lumen of the larynx by the membranous formation. Inspiration is wave-like or in jerks. The cough is moist but harsh, just as you found under Hepar. The voice is almost extinct from the hoarseness. The child grasps its throat to relieve the pressure, throws its head far back so as to straighten the route from the mouth to the lungs and favor the passage of air. It is particularly worse in the morning. Iodine is especially adapted to dark-complexioned children with dark hair and eyes. This in itself is a great distinction between Iodine and Bromine. That is why I spoke of the use of Bromine in light-complexioned children, because this fact has been proven to be a good distinction between these two drugs, and hence, as a comparative symptom, is one of great value to you. Iodine is particularly adapted to cases that come from damp weather. Long-continued damp cold weather will produce just such a cough as Iodine will cure. Do not change the remedy in these cases too often. Do not change your remedy on account of alarming symptoms that spring up, unless you are certain that they indicate a change.

Kaolin has been used successfully for membranous croup even when the membrane dips down deep into the trachea. There is extreme soreness of the chest. The patient does not want anything to touch him. He will not permit you to use steam or hot cloths, because the chest is so sore.

Returning to the study of Bromine, we find it useful in affections of the lungs. It is indicated in asthma, when the patient feels as if he could not get air enough into his lungs, consequently he breathes very deeply. The explanation of this lies not only in the lungs, but also in the constriction of the glottis. Although the patient expands his chest well, air does not go in on account of the narrowness of the opening in the larynx. It is especially indicated in asthma coming on, at or near the seashore.

We also find Bromine useful in pneumonia, particularly when it affects the lower lobe of the right lung, hence lobar pneumonia. We often find nose-bleed as a concomitant symptom when Bromine is indicated in these cases. The patient also has the symptom just mentioned under asthma, "seems as if he could not get enough air into the chest; " while there seems to be plenty of mucus, the patient does not appear to be able to expectorate it.

We also find Bromine indicated in tuberculosis of the lungs, particularly when the tubercular deposit is more manifest in the right lung. The patient suffers frequently from congestion of the head and chest, which is relieved by nose-bleed. Notice how often that symptom occurs under Bro?ni?ie. There is also pain in the mammary region going up into the axilla. The eyes seem to be affected along with the chest symptoms giving rise to a chronic conjunctivitis. Bromine produces a very characteristic picture of uncomplicated hypertrophy of the heart, by which I mean, muscular enlargement without valvular lesion. The patient finds it difficult to exert himself on account of the oppression about the heart. He has palpitation when he begins to move and when he gets up from a sitting to a standing posture. The pulse is full, hard and rather slow, which is just the character that belongs to an over-active enlarged heart. It has cured many cases of this hypertrophy of the heart. I think it was Dr. Thayer, of Boston, who cured many cases of this trouble with Bromine. It may also be used in cardiac asthma, especially when the asthmatic paroxysms are better at sea than on land.* You here find Bromine similar to Aconite, but it lacks the anxiety of that remedy. Both remedies are suited to uncomplicated cardiac * Professor Farrington refers above to the asthma of Bromine as coming on at or near the seashore, and here he speaks of cardiac asthma better on sea than on land. Both may be right, for being at sea differs from being at the seashore* where you may have land breezes.—S. 1^.

hypertrophy, but Aconite has fear and anxiety. The patient fears that he will drop dead in the street.

It is also similar to Aconite and Rhus tox., both of which remedies have uncomplicated hypertrophy of the heart from over-exertion.