REMOTE STORAGE 
 
 THE ABUSE OF BROMIDES 
 IN EPILEPSY. 
 
 BY 
 
 WM. P. SPRATLING, M.D., 
 
 SONYEA, N. Y. 
 
 Reprint from the Medical Record 
 
 September 2 , iqos 
 
 WILLIAM WOOD AND COMPANY 
 
 NEW YORK 
 
THE ABUSE OF BROMIDES IN EPILEPSY. 
 
 By WM. P. SPRATLING, M.D., 
 
 SONYEA, N. Y. 
 
 MEDICAL SUPERINTENDENT OP THE CRAIG COLONY FOR EPILEPTICS; 
 
 PRESIDENT OF THE NATIONAL ASSOCIATION FOR THE STUDY OF 
 EPILEPSY: MEMBER OF THE AMERICAN NEUROLOGICAL 
 ASSOCIATION, &C. 
 
 Years ago I became convinced that the bromides as 
 generally administered did vastly more harm in the 
 treatment of epilepsy than they did good, and the ten 
 years’ experience I have had at Sonyea in the treat- 
 ment of nearly two thousand cases has strengthened 
 that conviction. I do not hold that the bromides al- 
 ways do harm, or that they fail sometimes to do good 
 in the treatment of epilepsy. I think they have a 
 limited range of usefulness in the power they possess 
 of su ppressin g epileptic convulsions. 
 
 Biiticansay this without reservation : I have yet 
 to see the first case of epilepsy cured by the bromides 
 atone. Personally I have never given the bromide of 
 potassium to an epileptic. In certain of the epilepsies 
 in women in which the attacks group themselves 
 about the menstrual epoch, I have used some of the 
 other salts with good results, but even then the case 
 must be carefully selected. 
 
 When visiting the Bielefeld Colony in Germany 
 years ago, I learned that the bromides were con- 
 stantly being less employed. At the Craig Colony 
 the average dose of the drug now is fifteen grains a 
 day, five grains to a dose. Some patients get more 
 than this, while many get none. 
 
 Copyright , William Wood and Company. 
 
A short time ago the amount of the drug that was 
 being used was reduced nearly one-half. The result 
 was a considerable temporary increase in the number 
 of attacks, but in a little while the attacks fell to their 
 former number, most of the patients showing mental 
 and physical improvement while free from bromism. 
 To stop the bromides in a chronic epileptic — if it be 
 cautiously done — is sometimes more valuable than to 
 keep him saturated with them to the point of tolera- 
 tion. There is no better proof of the failure of the 
 bromides to cure epilepsy than to stop them after 
 years of use and watch the attacks double or treble in 
 number. 
 
 Sudden withdrawal of the bromides without an 
 effective substitute is never advisable. Some epilep- 
 tics will stand it, but others will be sure to succumb 
 to serial attacks, or to the graver condition of “status 
 epilepticus” which so frequently terminates in death. 
 Most, probably all, patent nostrums recognize the 
 power the bromides have of effecting false and su- 
 perficial “cures” in epilepsy — cures that terminate 
 with the withdrawal of the nostrum. During the 
 past nine years I have personally analyzed twenty- 
 seven inch nostrums and I found the basis of them 
 all, without exception, was the bromide of potassium. 
 
 In the hands of laymen these nostrums do infinite 
 harm. In contradistinction to the one point of value 
 bromide possesses in the treatment of epilepsy — that 
 of lessening cortical irritability — there are numerous 
 results from its unscientific use that sometimes make 
 it a positive menace to the recovery of the patient. I 
 ' am convinced that recoveries occasionally occur in 
 \ epilepsy, not because of the use of the drug, but in 
 Wpite of it. 
 
 The most remarkable recovery from epilepsy I 
 have known was in a man who had suffered from the 
 disease eighteen years, who had in all 50,000 to 
 
 2 
 
REMOTE STORAGE 
 
 60,000 seizures, who was given for years 120 to 140 
 grains of bromide with no effect but a steady depre- 
 ciation in his physical condition, and who began to 
 make a complete recovery after entering the Colony 
 where the amount of the drug was reduced month by 
 month until at the end of the eighth month he was 
 getting fifteen grains a day only. In this case an 
 effort was made to correct deep seated errors in 
 metabolism by giving a drug that only aug- 
 mented the primary fault. This single instance is 
 worth little more than to show that epilepsy is not 
 always relieved by bromide alone. But the point is : 
 there are thousands of other cases like it. 
 
 The chief difficulty in giving the bromides lies in 
 
 our inability to prescribe the precise individual dose 
 the patient’s condition demands. We have paid too 
 much attention in the past to the number of grains 
 administered, and too little to fesuHs^atfamed. Not- 
 withstanding its comparative harmlessnes'sTfhe drug 
 should be used in epilepsy with the same scrupulous 
 care that we use aconite in fever or digitalis in heart 
 disease if we expect to make our patients feel its 
 value, and miss its faults. 
 
 In no case let us forget there is a point of physio- 
 logical toleration — of therapeutic usefulness, beyond 
 \j* which we should not go. Barring exceptional cases, 
 it is never necessary to push it to the point of induc- 
 ing bromic acne, while to cause bromic dementia with 
 it, is a blunder inexcusable. For some years after its 
 opening the number of patients admitted to the Craig 
 with bromic dementia was greater than now. 
 
 Blunting of the intellectual faculties is a notable 
 result of the bromides, and is first shown in loss of 
 memory. I formerly thought this condition was du£ 
 to the seizures, but witnessing the complete restora- 
 tion of memory in so many cases after the bromides 
 
 3 
 
had for some time been withdrawn, there was no 
 alternative but to ascribe it to the use of the drug. 
 
 Since the origin of the Colony treatment of epi- 
 lepsy the bromides have, to a certain extent, declined 
 in favor. This decline was a logical result of the 
 rHrecognition of the necessity for the treatment of the 
 individual in toto, instead of aiming at the suppres- 
 sion of a symptom only. 
 
 We have only to consider the physiological effects 
 of the bromides to understand why they are of so 
 little use in epilepsy. On the respiration ordinary 
 doses produce but little effect; in larger doses they 
 act as depressants. On the alimentary canal they 
 often act disastrously — irritating the mucous mem- 
 brane and interferring with the reflex activity of the 
 stomach in a way to check the normal secretion of 
 gastric juice, which impairs digestion. They cause 
 constipation, heavy coating of the tongue, and foul 
 breath, a bad taste and a pasty feeling in the mouth, 
 loss of appetite and not infrequently nausea and 
 diarrhea. 
 
 On nutrition they act unfavorably in some cases 
 by lessening metabolic changes through depressing 
 the nervous system. They produce unsteady gait ; 
 myasthenia, particularly noticeable in the legs ; de- 
 pression and often loss of sexual vigor ; forgetfulness 
 and slight degrees of aphasia, usually shown in the 
 misuse of words and the wrong formation of sen- 
 tences. 
 
 On the temperature ordinary doses have no effect ; 
 in larger doses they lower the heat of the body by de- 
 pressing the heart’s action and possibly by contract- 
 ing the arteries, a fact apparently established through 
 the experiments of Brown-Sequard, Mairet, and 
 Amory.* 
 
 Some therapeutists assert that the bromides de- 
 crease tissue waste. I do not share this belief, but I 
 
 4 
 
am convinced that the opposite is oftener the case. 
 Epileptics are notoriously great eaters, and any sim- 
 ple increase in weight in them is not to be ascribed to 
 the bromides, but to their food habits. 
 
 Anemic, emaciated, and feeble epileptics who have 
 been taking large routine doses of bromides for years 
 before entering the Colony and who suffer its partial 
 or complete withdrawal after they begin Colony life, 
 show an increase in weight and a gratifying general 
 improvement difficult to believe. 
 
 It is an extraordinary fact that since the introduc- 
 tion of the bromides in the treatment of epilepsy by 
 Laycock, fifty-seven years ago, the prognosis of the 
 disease (barring certain well regulated forms of 
 treatment) is no better now than it was then. 
 
 After a few years of abandonment of the bromides 
 with the employment of other harmless depressants 
 in their stead, and a general recognition of the prin- 
 ciple of first treating the individual instead of a 
 symptom of his disease, we should soon attain a 
 truer estimate of the very limited value of the bro- 
 mides in epilepsy than we have to-day. 
 
 5