In some kinds of vomiting the bromides are most serviceable. The form of vomiting, to the treatment of which they are best adapted, is the reflex and the cerebral—as the vomiting of cerebral congestion, sea-sickness, pregnancy, etc. They are contra-indicated in all cases of vomiting due to primary gastric disturbance.

In the abdominal neuroses, of which cholera infantum is a type, the bromides are often highly effective, as the author has long known, and as Spender has lately advocated; but, according to the author's observation, it is useless, if not injurious, when defective alimentation is the cause of the attacks, and is serviceable just in proportion to the degree in which an irritable state of the nervous system dominates the gastro-enteric disturbance. When the cause of the attacks is heat, or reflex irritation of the fifth pair, as in teething, or cerebral congestion, very excellent results are obtained from the use of the bromide of potassium. Rx Potassii vel sodii bromidi, 3 ij; syrup, simplicis, oz ss; aquae menthae pip., oz jss. M. Sig.: A tea spoonful every hour or two. The author has had excellent results from the use of the bromides in the flatulent colic, the restlessness, and crying fits of infants, Rx Potassii vel sodii bromidi, 3 j; ol. anisi, τη ij; mucil. acaciae, aquae menthae pip., āā oz j. M. Sig.: A tea spoonful every half-hour until relief is experienced.

Increased action of the heart (hyperkinesis) due to irritation of the sympathetic, as, for example, such as occurs in exophthalmic goitre, is calmed by the bromides. The irregular and too frequent action of the heart, occurring in hysterical subjects of plethoric constitution, is generally relieved in the same way; but the bromides are contraindi-cated in all cases dependent on anaemia. Disturbed action (overaction) of the heart, with cerebral hyperaemia, is frequently most advantageously treated by a combination of digitalis and a bromide: Rx Inf. digitalis, oz iv; potassii bromidi, oz ss— oz j. M. Sig.: A table-spoonful morning and evening.

Da Costa has, in several publications, strongly urged the use of the bromide of ammonium in acute rheumatism. Doubtless, other bromides (potassium, sodium, lithium) would be as effective, and are certainly much less disagreeable. The author has used the bromide of lithium with considerable apparent success, in subacute rheumatism, in rheumatic gout, and to remove the stiffness and nodosities of joints remaining after attacks of the above-named rheumatic affections. The wakefulness, delirium, and hyperpyrexia, which sometimes complicate rheumatism and gout, are best treated by bromide of lithium, pain being relieved by morphine if necessary.

It has been stated that the bromides, especially bromide of ammonium, diminish the deposition and hasten the retrograde metamorphosis of the fat in obesity. Undoubtedly these agents increase waste, but they do so, chiefly, in consequence of a severe gastric catarrh which they set up.

Rabuteau has proposed the use of the bromides as eliminating agents in cases of mercurial, cupric, or saturnine poisoning. These agents, more efficiently than the iodides, combine with the deposited minerals, convert them into soluble combinations, and thus cause their elimination. The best results are probably obtained by a combination of the bromide and iodide of potassium.

The most important therapeutical applications of the bromides of potassium, sodium, lithium, etc., are in the treatment of cerebral disorders from overaction. The bromides acting on the heart slow its movements, and, on the vaso-motor nerves, diminish the intra-cranial blood-supply. The best results are obtained in the treatment of cases in which there is no anaemia on the one hand, or inflammatory reaction on the other; cases in which the intra-cranial blood-supply is in excess, because the vaso-motor regulating centers are wanting in activity. The most typical representation of this condition is seen in wakefulness from cerebral overwork. No clinical fact is more conspicuous than that the bromide of potassium will relieve wakefulness of this kind. The hypnotic action of the bromides is not a certain action like that of chloral, nor like that of morphine under appropriate conditions; considerable mental excitement and an active cerebral congestion may entirely prevent the hypnotic effect. Wakefulness from mental worry, fatigue, unrest of the peripheral nerves (fidgets), and similar causes, will generally be relieved by the bromides. For this purpose a cumulative action is generally desirable, effected by giving a dose of fifteen grains before each meal, and one of thirty grains on retiring. The manner in which the hypnotic action of the bromides is limited by certain states of the intra-cranial circulation is well exhibited in delirium tremens. In the condition of nervous excitement and wakefulness which precedes the delirium, and which is known as "horrors," the action of the bromide is most satisfactory; it quiets the restlessness and induces sleep. For this purpose considerable doses are necessary—a drachm every four to six hours. When, however, delirium tremens is fully developed, this remedy is much less efficient, and frequently fails altogether to produce sleep. It is more serviceable in the first than in subsequent attacks of horrors, and its utility diminishes as the structural alterations of chronic alcoholismus increase.

In some cases of maniacal excitement the bromides produce excellent effects, but they very frequently fail without apparent reason. In acute mania accompanied by heat of head, injected conjunctivae, and restlessness, refreshing sleep may follow the administration of one full dose; but the remedy fails more frequently than it succeeds. In puerperal mania of the sthenic form, with rather quick and full pulse, hot head, and injected conjunctivae, the author has witnessed excellent results from the use of the bromide of potassium; but it has rather increased the delusions and the depression when the type of the case was melancholic, with systemic weakness and anaemia. A similar experience has been had in the use of the bromides in hypochondriasis and melancholia. These forms of mental trouble are most usually accompanied by bodily weakness, and are rather increased by the use of the bromides; but it occasionally happens that these agents give an amount of relief afforded by no other drug or combination of drugs. It is impossible to indicate, in the present state of our knowledge, the particular cases in which the bromides may be serviceable, but the author ventures to express the opinion that the state of the intra-cranial circulation, which may be ascertained on ophthalmoscopic examination, will furnish the true guide. It need hardly be observed that the bromides are useless when wakefulness is dependent on pain.