There are certain distressing phthisical symptoms which are amenable to the influence of bromides on vaso-motor nerves and reflex action. Thus, a hacking, laryngeal cough, or reflex vomiting, or even pyrexia, may be relieved; also the difficulty and pain in deglutition connected with pharyngeal irritation. Profuse sweating and even flux from the bowels may be controlled by the bromides - especially by bromide of calcium - though usually the anaemic and depressed condition may be met better by acids or mineral astringents.

Insomnia is but a symptom, and one produced by various and often opposite pathological conditions. We accordingly find that the different hypnotics cannot be used with equal success in all cases presenting this one symptom in common, and so, while bromides are of most signal value in some conditions, they are useless or even harmful in others. This may be explained partly by varying conditions of the blood-supply, partly by difference in the states of nutrition of the nerve-cells. It is when there is moderate cerebral hyperoemia, such as probably exists after prolonged mental effort - whether associated with study, with excitement, or anxiety - and when unrest and sleeplessness are marked symptoms, that the bromides are far more soothing and more curative than opium; and even if inflammatory action be present, they may still be very serviceable, in conjunction with aconite, ice, or other remedies.

If there be much cerebral anoemia, it may even be increased by the remedy, and I have seen, in debilitated hypochondriacs, and in some aged people, aggravation of the symptoms with marked increase of the prostration. In some cases of senile insomnia, I have, however, found it very useful given with the last meal, in doses of 10 to 20 gr. or more, dissolved in milk, tea, soup, beer, or cold water. In the sleeplessness of convalescence from acute disease and of dyspepsia, bromide is useful, combined in the latter case with dietetic and other special treatment. In pregnancy, where pain is suffered and prevents sleep, a combination of chloral and bromide - 15 gr. of each - is especially useful. In weakly subjects, and especially in the insane or hypochondriacal, bromide is best given in combination with cannabis indica. When insomnia is induced by severe pain, opium is the best remedy; but its effect is heightened, and its tendency to produce headache, faintness, and nausea lessened, by bromide. Da Costa recommends the latter to be given in full doses half an hour before, and two hours after, the opium.

To choose a suitable quantity is of importance; it is usually from 20 to 30 gr.

Wolfe relates a case of insomnia with hypochondriasis and irritability, from over-anxiety, when 5 gr. proved useless, but 1/2 dr. "acted like a charm." Behrend relates two very good illustrations of nervous excitement and anxiety, with loss of sleep, in which 25 gr., at first thrice daily, afterward less often, proved quickly curative (Lancet, i., 1866; ii., 1864, p. 1). In the sleeplessness and delirium of fevers, the bromides exert a favorable influence in procuring sleep, and they prove a valuable resource when opium is not admissible.

I have sometimes found bromide of camphor, in 3 to 5 gr. doses, procure sleep for hysterical subjects, and Deboul recommends it in the unrest of cardiac disease, and of phthisis (British and Foreign Review, i., 1865). The solid capsule of Clin is liable to cause gastric irritation, and is better given dissolved in milk.