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November, 1942 BROMIDE INTOXICATION—GARRARD 597 fluid is injected into the cavity. The solution is withdrawn and reinjected into the sac, this procedure being repeated about four times or until the walls of the sac are thoroughly washed. A small amount, 1 to 2 cc., is left in the sac, and the needle is withdrawn. If the fluid is cloudy after washing the walls of the sac, some fresh fluid can be injected by attaching another syringe. Most cases require only one treatment. Occasionally two or three treatments may be necessary. Conclusion The injection treatment is an inexpensive scientific, and safe method of therapy if used in selected cases. The procedures are simple and the results pleasing. BROMIDE THERAPY AND INTOXICATION Robert L. Garrard, M. D. Greensboro Bromides are a valuable aid in the management of tension states, anxiety, and insomnia. They have been extensively used in the treatment of epilepsy, although during recent years they have been replaced to a large extent by phenobarbital and dilantin. Bromides tend to irritate the gastric mucosa, and should therefore be diluted before administration. A blood level of around 125 mg. per 100 cc. of blood is considered about the upper limit of safety. This varies widely, however, so that some patients can tolerate 300 mg. or more with few signs of intoxication, while others show evidence of poisoning on less than 100 mg. per 100 cc. Blood level determinations should be made occasionally, so that the level will not exceed a toxic concentration. Wuth(1) was largely responsible for awakening interest in bromide intoxication in this country, and his procedure, devised about thirty years ago, is the most convenient means of quantitative estimation of bromides in the blood. The high incidence of bromide intoxication has been due in large measure to the unrestricted sale of sodium bromide and of various preparations containing bromides, such as Elixir of Five Bromides, Peacock’s Bromides, and pain-killers such as BC Powders, Stanback, Goodies, Bromo-Quinine 1. Wuth, O.: Rational Bromide Treatment, J.A.M.A, 88: 2013-2017 (June 25) 1927. Bromo-Seltzer and Bromidia. More than two hundred patent medicines contain bromides. In 1935 the American Association of Pharmacy stated that the number of prescriptions calling for bromides is exceeded only by those containing aspirin. Such prescriptions can be refilled, and this unfortunately leads to extensive self-medication. Bromide preparations are much used in the treatment of headaches, insomnia and symptoms incident to chronic alcoholism. Solomon describes the pharmacological action of bromides as follows: “They depress the entire central nervous system with the exception of the medulla, depressing the psychic functions, the motor cortex and spinal cord, lowering its reflex excitability. The muscle tone is lowered throughout the entire body. Ordinary doses have no effect on the circulation, but larger doses depress the heart and vasoconstrictor center. They lessen arterial tension and lower body temperature, depress sexual appetite and power and cause pallor, acne on face and extremities, a coated tongue, disordered digestion, emaciation, somnolence, sluggish reflexes and defective coordination. They may be responsible for impairment of the mental faculties, with hallucinations and delusions, or cause melancholia or maniacal excitement.” Normally, there is very little bromide in the blood stream, the level varying between zero and 3 mg. per 100 cc. of blood(2). Bromide is used in therapy because it depresses the nervous system. A blood level above 150 mg. is termed by Wuth as the “toxic zone”; however, it is well known that some persons, otherwise healthy, seem to lack resistance and become delirious on a much lower concentration. A person using little or no salt will become intoxicated with greater ease. The older the patient, the greater is the danger of poisoning. A level of 300 mg. without symptoms is rare, regardless of age. According to Bernoulli, a replacement of over 40 per cent of the blood chlorides by bromides will prove fatal. Sharp states that bromides may be excreted in sweat, tears, mucus, urine, feces, semen and milk. The bromide in the tears probably causes conjunctivitis by irritation. Bromides are absorbed by the stomach and appear in the 2. Wikoff, H. L., Brunner, R. A.. Allis-on, H. W.: The Normal Bromine Content of the Blood of Healthy Individuals, Am. J. Clin. Path. 10:234-237 (March) 1940.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-003.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 597 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1942 |
Identifier | NCHH-17-003-0607 |
Form General | Periodicals |
Page Type | all; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed31942medi_0607.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 3 |
Issue Number | 11 |
Page Number | 597 |
Health Discipline | Medicine |
Full Text | November, 1942 BROMIDE INTOXICATION—GARRARD 597 fluid is injected into the cavity. The solution is withdrawn and reinjected into the sac, this procedure being repeated about four times or until the walls of the sac are thoroughly washed. A small amount, 1 to 2 cc., is left in the sac, and the needle is withdrawn. If the fluid is cloudy after washing the walls of the sac, some fresh fluid can be injected by attaching another syringe. Most cases require only one treatment. Occasionally two or three treatments may be necessary. Conclusion The injection treatment is an inexpensive scientific, and safe method of therapy if used in selected cases. The procedures are simple and the results pleasing. BROMIDE THERAPY AND INTOXICATION Robert L. Garrard, M. D. Greensboro Bromides are a valuable aid in the management of tension states, anxiety, and insomnia. They have been extensively used in the treatment of epilepsy, although during recent years they have been replaced to a large extent by phenobarbital and dilantin. Bromides tend to irritate the gastric mucosa, and should therefore be diluted before administration. A blood level of around 125 mg. per 100 cc. of blood is considered about the upper limit of safety. This varies widely, however, so that some patients can tolerate 300 mg. or more with few signs of intoxication, while others show evidence of poisoning on less than 100 mg. per 100 cc. Blood level determinations should be made occasionally, so that the level will not exceed a toxic concentration. Wuth(1) was largely responsible for awakening interest in bromide intoxication in this country, and his procedure, devised about thirty years ago, is the most convenient means of quantitative estimation of bromides in the blood. The high incidence of bromide intoxication has been due in large measure to the unrestricted sale of sodium bromide and of various preparations containing bromides, such as Elixir of Five Bromides, Peacock’s Bromides, and pain-killers such as BC Powders, Stanback, Goodies, Bromo-Quinine 1. Wuth, O.: Rational Bromide Treatment, J.A.M.A, 88: 2013-2017 (June 25) 1927. Bromo-Seltzer and Bromidia. More than two hundred patent medicines contain bromides. In 1935 the American Association of Pharmacy stated that the number of prescriptions calling for bromides is exceeded only by those containing aspirin. Such prescriptions can be refilled, and this unfortunately leads to extensive self-medication. Bromide preparations are much used in the treatment of headaches, insomnia and symptoms incident to chronic alcoholism. Solomon describes the pharmacological action of bromides as follows: “They depress the entire central nervous system with the exception of the medulla, depressing the psychic functions, the motor cortex and spinal cord, lowering its reflex excitability. The muscle tone is lowered throughout the entire body. Ordinary doses have no effect on the circulation, but larger doses depress the heart and vasoconstrictor center. They lessen arterial tension and lower body temperature, depress sexual appetite and power and cause pallor, acne on face and extremities, a coated tongue, disordered digestion, emaciation, somnolence, sluggish reflexes and defective coordination. They may be responsible for impairment of the mental faculties, with hallucinations and delusions, or cause melancholia or maniacal excitement.” Normally, there is very little bromide in the blood stream, the level varying between zero and 3 mg. per 100 cc. of blood(2). Bromide is used in therapy because it depresses the nervous system. A blood level above 150 mg. is termed by Wuth as the “toxic zone”; however, it is well known that some persons, otherwise healthy, seem to lack resistance and become delirious on a much lower concentration. A person using little or no salt will become intoxicated with greater ease. The older the patient, the greater is the danger of poisoning. A level of 300 mg. without symptoms is rare, regardless of age. According to Bernoulli, a replacement of over 40 per cent of the blood chlorides by bromides will prove fatal. Sharp states that bromides may be excreted in sweat, tears, mucus, urine, feces, semen and milk. The bromide in the tears probably causes conjunctivitis by irritation. Bromides are absorbed by the stomach and appear in the 2. Wikoff, H. L., Brunner, R. A.. Allis-on, H. W.: The Normal Bromine Content of the Blood of Healthy Individuals, Am. J. Clin. Path. 10:234-237 (March) 1940. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://hsl.lib.unc.edu/specialcollections/nchealthhistory/nchh-17-pdf |
Document Sort | all; nchh-17 |
Article Title | Bromide Therapy And Intoxication |
Article Author | R L Garrard |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-003 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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