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( Originally Published 1940 )
"NERVOUSNESS" in one form or another is very common. Some psychiatrists believe it is universal. Few people are so well adjusted psychologically that they can face all life's problems with equanimity and never be troubled by an attack of "nerves," especially in these days of war, civilian bombings, racial persecution, unemployment and economic insecurity.
It is a truism that social and economic conditions have a profound effect upon emotions and behavior. In times of social and economic crises, the nervous system is subject to more shocks and bruises than usual. The person with some form of psychological instability will feel the impact of socio-economic difficulties more than the psychologically well-adjusted person. And to the psychiatrists, the latter is almost as rare as hen's teeth.
The physician sees some evidence of nervous or emotional tension in almost all his patients. Even when there is organic disease such as a tumor or an infection, the physician must frequently find a way of treating the emotional reactions of the patient to his disease. This is never easy, and the physician often finds it necessary to prescribe a sedative such as the bromides until the patient has made an adjustment to his ailment. The task of finding an appropriate remedy for emotional difficulties is infinitely harder when the physician is dealing with that large group of nonorganic ailments that constitute the bulk of his practice. These are the so-called functional disorders, disorders for which no organic cause can be found and which manifest themselves in disturbance of functioning of an organ or a system of organs.
The digestive tract is the most common seat of such functional disorders; spastic constipation, "nervous indigestion" and "mucous colitis" are the very common disorders seen in daily practice. Other organs and systems also participate in disturbances of functioning.
Finally, there is a large group of disorders in which the symptoms are mainly or entirely mental. If the symptoms are mild, the disorder is termed "nervousness." There are few who have not experienced a feeling of tension or an attack of "jitters." Many people get such attacks frequently and often without apparent cause. When the attacks of nervousness, anxiety or "jitters" are severe and frequent the disorder is known as a neurosis or psychoneurosis. Many psychiatrists look upon neurosis not as an illness but as a way of reacting to problems—in certain respects merely an exaggeration of ordinary behavior.
In any event, the symptoms and disorders of functional disturbance are many. Patients with a severe disturbance need constant or frequent care by a physician. If the symptoms are mainly psychological or mental, psychiatric treatment is necessary.
Many patients, moreover, need a crutch to help them get along until a better adjustment can be made. The sedative drugs such as the bromides and phenobarbital provide such a temporary support. Unfortunately many people tend to live and sleep on their crutches; and what was intended as a temporary solace or support becomes a poison that endangers physical and mental health.
That the bromide drugs (sodium, potassium, ammonium, calcium, lithium and strontium) are double-edged weapons, capable of doing a great deal of good and also much harm, is becoming more acutely recognized in medical circles. The U. S. Food & Drug Administration and the U. S. Public Health Service recognized this danger and in the new Federal Act placed the bromides among those drugs whose quantities in any proprietary preparation must be stated on the label. Recent articles in medical journals also warn physicians against the dangers of bromide intoxication or "bromism."
Many instances of poisoning are due to self-administration of bromide preparations by patients who first learned of their sedative effects from a doctor's prescription, and who then continued to have the prescription refilled repeatedly, usually without the doctor's knowledge. There are no Federal or local laws to prevent a person from repeatedly renewing prescriptions containing bromides. Nor are there laws that prevent him from buying official bromide preparations (Elixir Triple Bromide, Triple Bromide Tablets and Effervescent Triple Bromides) in unlimited quantities and with-out a doctor's prescription. And finally, the patent-medicine industry—the hobgoblin in all matters of health—has introduced hundreds of remedies containing bromides on the market.
A great many proprietary headache remedies contain bromides. According to the Food & Drug Administration, Bromo-Seltzer contains in each dose 6.5 grains of sodium bromide as well as 4 grains of acetanilid; a Stan back powder contains 11.6 grains of potassium bromide as well as about 2.1 grains of acetanilid and 5.8 grains of aspirin; a B-C pow-der contains 12 grains of potassium bromide as well as 3.8 grains of acetanilid.
It is apparent that acetanilid addicts may take a respect-able amount of bromides daily. Those who take their bromides straight will absorb more. Fortunately, there is little danger of addiction to bromides as there is to acetanilid, and relatively few deaths have been reported from bromide poisoning. But as with acetanilid, there is a danger of poisoning; and like acetanilid, bromides taken in excessive doses or over long periods can cause or aggravate the very symptoms they were intended to relieve.
Headache, fatigue, "nervous stomach," anxiety and insomnia are among the symptoms of everyday nervousness or neurosis for which bromides are taken. In moderate doses, for short periods and under the supervision of a physician, the drug can give a deal of comfort. But the relief is temporary and symptoms will return unless the underlying nervous condition is eased or corrected.
Some people show an idiosyncrasy or sensitivity to the drug and cannot take even moderate amounts of bromides without getting a bromide eruption. This eruption resembles acne very closely, and dermatologists usually ask patients with acne whether they are taking bromide preparations or headache remedies.
In large doses and taken over a period of weeks or months, the drug tends to accumulate in the tissues and cause symptoms of poisoning. Headache, "nervous indigestion," anxiety and nervousness may reappear with increased intensity. Digestive disturbances may be particularly marked. Even new mental symptoms may appear. And it occasionally happens that these symptoms become so alarming that the patient is believed to be suffering from a serious mental disturbance and is committed to a psychopathic hospital. Since bromides, like ordinary salt (sodium chloride), are excreted by the kidneys, intoxication is more likely to occur in those with kidney disease or in elderly people, in whom kidney function is frequently somewhat impaired.
It is well to keep in mind that a bromide, like any other drug, becomes a poison when the tissues of the body receive more of the drug than they can handle. Since the body possesses powers of repair and resistance, much damage must be done by the drug before symptoms of poisoning which can be recognized, either by the patient or by the physician, develop. This is the most insidious danger of self-medication.
Once bromide intoxication is suspected, however, the diagnosis is fairly easy. There are no characteristic symptoms and signs, but an analysis of the content of bromide in the blood can be quickly made and the correct diagnosis thus easily established. Fortunately, also, the treatment is simple and usually effective. The use of the drug is discontinued and large amounts of ordinary salt given by mouth or by injection in solution. The salt will replace the bromides in the tissues and the bromides will be excreted by the kidneys, relieving the patient of all symptoms of intoxication.
It has long been known that many persons can take a large amount of bromides without any symptoms or signs of intoxication. Others, however, are not so tolerant, and while there is a great variability in the tolerance of people for different drugs, it would be wise to avoid large or prolonged dosing by bromides. All proprietary remedies advertised for "nerves," "jitters" and insomnia should also be avoided, since almost all of them contain bromides. When the labeling provisions of the new Federal law go into effect, bromide remedies sold in interstate commerce will be required to state on the label the presence and amount of bromide. But that is the only protection the public gets and it is a negligible one until consumers recognize the dangers of indiscriminate dosing.
According to the Food 8c Drug Administration and the Bureau of Investigation of the American Medical Association, the following proprietary preparations have been re-ported to contain bromides. The list does not include official bromide preparations:
B. B. Headache Powders
More powerful than bromides are the so-called hypnotic drugs—barbituric acid and its derivatives, phenobarbital or Luminal, and many others. The presence of these drugs in a proprietary medicine sold in interstate commerce must be stated on the label, together with the statement: "Warning —May Be Habit Forming." That is the chief danger of these drugs—the tendency to cause habit formation; for occasional use when prescribed by a physician they can give a great deal of comfort. Indiscriminate dosing will cause trouble.