The use of bromides in insane patients requires special study and care, because of their liability to be suddenly depressed, and the prostration I have sometimes seen well illustrates the clinical fact that an enfeebled, ill-nourished nervous system often contra-indicates these medicines, even if the general bodily health seems to be fair.

Dr. S. W. D. Williams records that, of thrity-seven insane epileptics treated by bromides, the fits were relieved in most, but great depression occurred in some of them without any relief to their attacks; 1/2-dr. doses proved too large; catharsis was caused in two cases, and possibly the rapid development of phthisis in a third (Medical Times, ii., 1864, p. 88).

Mr. Wood (Durham) has also recorded instances among insane patients of "sudden development of severe prostration and despondency (British Medical Journal, ii., 1871); vomiting and abdominal pain were also caused.

Dr. Clouston, in a careful study of the effects of different medicines upon the nerve-condition of lunatics, found that the bromides, if given alone, needed to be used in very large doses for the subduing of violent paroxysms. One female patient took 7 oz. in divided doses, but then suddenly lapsed into a condition of extreme "torpid depression," not free from danger to life, and continuing many days. The same physician ascertained that a combination with cannabis indica gave, even in small doses, much better results than either remedy alone, 1/2 dr. of each given together acting as a hypnotic better than 1 dr. of tincture of cannabis indica, or 2 dr. of bromide (Medico-Chirurgical Review, ii., 1870, and 1871).