Observations and experiments on the use of opium, bromide of potassium, and cannabis indica in insanity, especially in regard to the effects of the two latter given separately / by T. S. Clouston, M.D.

  • Clouston, T. S. (Thomas Smith), 1840-1915.
Date:
[1871], [©1871]
Catalogue details

Licence: Public Domain Mark

Credit: Observations and experiments on the use of opium, bromide of potassium, and cannabis indica in insanity, especially in regard to the effects of the two latter given separately / by T. S. Clouston, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    21/42 (page 19)
    she was as excited as ever, but her tongue was beginning to get furred in the centre with a raw Hne down each side, and there seemed slight muscular unsteadiness. Her pulse too was somewhat weaker. The medicine was given for another day and a half, until she had got seven ounces of it. The maniacal excitement then quite suddenly abated, and her mental state became one of torpid depression. She became pale and pinched-looking, the ])upils sluggish, the pulse 108 and very weak, and the temperature fell to 96°. These symptoms increased after the medicine was discontinued, until the co-ordinating power of the muscles was so completely lost that she reeled like a most intoxicated man when she attempted to walk. She slept, almost continuously, for three days. She only took food when given to her, and seemed not to care for it. Her bowels were regular. Her tongue was at first furred with a thick white fur, and then got quite raw-looking. Her breath smelt of bromide of potas- sium. Her articulation was much affected. She remained in this state for about five days, her temperature remaining at 96°, and it was quite a fortnight from the time it was discontinued before she got over the effects of the drug. As she got better there was slight feverishness with dry tongue and want of appetite. The excitement did not return when the effects of the drug passed off; but the next attack began on the 10th of April, which was sooner than it ought to have come on by a week at least. This experiment is instructive, as showing, 1st, that the most acute excitement can be subdued by bromide of potassium ; 2nd, that this cannot be done without pushing the medicine far beyond what is safe; indeed, almost up to complete paralysis of the cerebrum and sympathetic ganglia of the heart; 3rd, that the action of the drug in such a case is strongly cumulative, increasing in intensity for days after it has been stopped, and lasting for a long time; and 4th, that no permanent improvement is necessarily produced in the morbid cerebral action. I do not regard this a case of cutting short the excitement. It was rather one of half-poisoning the patient. If any justification of such an experiment is needed, I must plead the importance of knowing exactly the effects of the bromide on maniacal excitement, the hope that benefit might possibly accrue to the patient, and the absolute want of any precedent to guide me. It seems to me highly instructive, clinically as well as physiologically. Such a case should show the necessity for stopping the bromide at once when its bad effects are first observed, on account of this cumulative action. It illustrates the prolongation of the effects of tin's as compared with any other drug that has the power of producing the same narcotic or paralytic action on the nervous system. It proves that maniacal excitement gives the same tolerance to the system in resisting the ordinary physiological effects of this drug as in the case of the ordinary vegetable narcotics. 3