Some kinds of neuralgia are much benefited by the bromides. The congestive form of migraine, or sick-headache, is generally quickly dispelled by one or more full doses. The form of migraine in which it acts almost as a specific is that characterized by a flushed face, throbbing temples, injected conjunctivae, eyes intolerant of light. The bromides often give great relief in the fugitive nerve-pain of hysterical women; but they are quite ineffectual in neuralgia fixed in a nerve, as, for example, in trigeminal neuralgia, sciatica, etc. The bromide of potassium is often quite successful in ovarian neuralgia, and in the nervous unrest which grows out of ungratified sexual instinct in men and women.

Very remarkable results have been obtained by the use of large doses of bromide of potassium in tetanus. H. C. Wood gives a tabular statement of fifteen cases which he has collected, in which the bromide of potassium was the chief or the only agent used, and of these but two died. No results equal to this have been achieved by any other agent, not even by Calabar bean. In order to succeed with this remedy it must be given in large doses ( 3 j every three or four hours). A combination with chloral is also highly effective, but these agents exert a powerfully depressing action on the heart.

Cases of strychnine-poisoning have been reported cured by full doses of the bromide of potassium. One case is narrated by Dr. Gillespie in which three grains of strychnine were taken, and the lethal effects were obviated by one ounce of bromide of potassium in divided doses.

No therapeutical fact is better established than the influence of bromide of potassium over epilepsy and epileptiform seizures. But the curative power of this agent in epilepsy has numerous limitations. It has been well ascertained that bromide of potassium is most valuable in those cases of epilepsy characterized by frequent and violent convulsive seizures. Epileptiform attacks, dependent on the presence of a tumor or other coarse organic lesion of the brain, are usually suspended by the use of this agent, although the neoplasm is unaffected in its growth and development. It is a curious circumstance that attacks, nocturnal exclusively, are less amenable to the bromide-treatment than those which occur in the daytime.

Cases of the petit mal, or epileptoid seizures, in which there is temporary loss of consciousness without convulsion, or with a transient spasm of the facial muscles, etc., are as a rule not so much benefited as are cases of the grand mal. Hysterical convulsions (hystero-epilepsy) are benefited by the bromide in the degree in which they partake of the nature of true epilepsy. Simple hysterical convulsions are rarely improved even by a course of this medicine. It has been repeatedly shown, as was first observed by Sir Charles Locock, that the bromides are especially efficacious in cases of epilepsy of sexual origin.

Although the bromide of potassium is less effective in the epilepsy of childhood than of adults, it is an excellent remedy in infantile convulsions dependent on reflex irritation. After the removal of the irritation the convulsive attacks may continue, but they can be arrested by the use of the bromides. The cerebral congestion which precedes the convulsive seizure may be relieved by this agent, and the threatened attack averted. The author is convinced that the convulsions which attend tubercular meningitis may be prevented by the bromide, but this agent exerts no curative influence in this fatal malady.

In the present state of our knowledge it is not possible to indicate with any degree of certainty, besides the points mentioned above, the kind of cases in which a successful result may be expected from the bromide treatment. If no improvement be manifest after several weeks of treatment, and if bromism be induced, the case must be regarded as an unfavorable one for this treatment. Brown-Séquard thinks that the cropping out of an "acne-like eruption on the face, neck, shoulders," etc., is an evidence that the bromide is proving curative, and he even asserts that there is "a positive relation between the intensity of the eruption and the efficacy of the remedy against epilepsy." According to Voisin, the abolition of reflex nausea—ascertained by passing a spoon as far back as the epiglottis, without causing attempts at vomiting—is an indication of the successful action of the remedy. Furthermore, he regards the following physiological effects as evidence of curative power: " Hypnotic manifestations, general lassitude, an easy and rapid disappearance of reflex nausea, and antaphrodisiac action."

Certain cases of epilepsy, in which the bromide of potassium fails to afford relief, are greatly benefited by strychnine. From this circumstance it has been concluded that the former agent is most serviceable in cases in which a condition of hyperaemia of the brain exists, and that the latter agent produces the best effects when a condition of cerebral anaemia is present.

Various important considerations are connected with the administration of the bromides in epilepsy. The daily dose required varies from half a drachm to four drachms, the limit of the quantity administered being determined by the effect produced. The occurrence of bromism and the arrest of the seizures are the evidences that a sufficient quantity has been introduced into the organism. According to the author's experience, forty grains of the bromide, dissolved in water and given before each meal, or three times a day, and if required a double dose at bedtime, is an amount of the medicine which it is rarely necessary to exceed. When the convulsive attacks have ceased, a single dose of sixty grains at bedtime will generally suffice; but this result must not be interpreted too favorably, and the remedy discontinued, for an immense experience has now demonstrated that security against a return of the attacks can only be attained by a continuance of the remedy for two or more years after all indications of epilepsy have disappeared. After the continuous use nightly of the remedy for a year, the dose may be so far diminished as to give it on alternate nights. Should the attacks recur after temporary cessation, larger doses are required as a rule.