Kalium bromatum:Homeopathic Remedy of the Acnes

- VERMEULEN Frans,
Kali-br.

Kalium bromatum

Morals are an acquirement - like music, like a foreign language, like piety, poker, paralysis - no man is born with them.
[Mark Twain]
Signs
Potassium bromide.
CHEMISTRY Colourless crystals or white granules or powder, consisting of 67.14% bromine and 32.86% potassium. Hygroscopic and sensitive to moisture. Dissolves readily in water: 1 gram dissolves in 1.5 ml water and in 1 ml boiling water. It is very stable compound, but incompatible with strong oxidizing agents, strong acids, bromine trifluoride and bromine trichloride.
USES Used in manufacture of photographic papers and plates; in process engraving; for the manufacture of special soaps; in spectroscopy and infrared transmission; as a laboratory reagent.
MEDICINE Potassium bromide is an very old anticonvulsant, which was used in the 1800s as both an anticonvulsant and sedative. It was first prescribed as a substitute for potassium iodide, under the idea that it possessed similar curative qualities. It was used for secondary syphilis, mercurial poisoning, enlargements of the liver, spleen, tumours, scrofula, etc. Jackson was the first to recommend it in epilepsy, based on the idea that by removing the syphilitic disease the epilepsy would disappear. In later years it was recommended and used in whooping cough and various spasmodic affections.
TOXICITY Potassium bromide causes central nervous system depression, eye and skin irritation, and digestive tract irritation with nausea, vomiting, and diarrhoea. The central nervous system depression is characterised by excitement, followed by headache, dizziness, blurred vision, unconsciousness, coma and possible death due to respiratory failure. Prolonged exposure may cause mental changes such as hallucinations, depression, memory loss, irritability, ataxia, psychosis, and possibly coma. Chronic bromism has been associated with toxic psychosis resembling paranoid schizophrenia, personality changes, and mania with paranoid delusions. Administration of sodium chloride will increase the elimination of potassium bromide from the kidney, since chloride will be conserved at the cost of bromide. High salt diets decrease the effects of potassium bromide. As an oral medication it is used to control seizures and epilepsy in dogs, although it may take 4-5 months before full effects occurs. Signs of overdosing [in dogs] include drowsiness, loss of appetite, vomiting, constipation, pancreatitis, muscle pain, staggering, decreased or slow reflexes, pupils of different sizes, and tremors.
EYES Overdosage of potassium bromide has no uniform effect on the eyes, but very commonly pupils are large and have a subnormal reaction to light or accommodation. A survey of eye disturbances in 70 cases of bromide poisoning demonstrated frequent mydriasis, disturbances of apparent colour of objects, blurred vision, apparent movement or wiggling, and change in apparent size of objects; visual hallucinations were common, photophobia was rare. 1
BROMIDES Bromides, mainly potassium bromide and sodium bromide, has been prescribed for decennia as sedatives, soporifics, and anticonvulsants. They have now been largely replaced by drugs with less side-effects. Large doses of the bromides can cause central nervous system depression and mental deterioration. Chronic bromide intoxication - called bromism - is characterized by violent delirium [occasionally], psychotic behaviour, confusion, drowsiness, headache, acneform eruption, seborrhoea, slurred speech, cardiac depression, foul breath, anorexia, nausea and vomiting, gastric pains, and muscular weakness [ataxia; paralysis]. According to Leeser, bromine represents the high point in the narcotic effect of the halogen series.
PROVINGS •• [1] Höring and Heimerdinger - self-experimentations, 1838; method: daily doses of 1 grain, gradually increased, and 4 grains daily for 17 days and 8 grains daily for 13 days.
•• [2] Graff - 9 provers; method: daily doses of solution, afterwards increased and repeated.
•• [3] Laborde - self-experimentation, 1869; method: 'took in 2 doses at 1/2 hour interval 15 grams dissolved in a glass of eau sucré.'
•• [4] Krosz - 3 provers, 1876; method: doses of 5-8 grams.
REFERENCES Allen's list of references includes 17 observations of effects of potassium bromide in epileptic patients, 3 observations in paralysis agitans, and 2 in insomnia. Among the 'healthy provers' are "epileptic patients, all more or less insane." [source 28 in Allen]
Hale explains where most of the symptoms come from: "The doses in which it has been prescribed [by the allopathic school] have been in many instances enormous; poisonous we may say. This reckless and criminal manner of giving the drug, however, has been the means of giving us many pathogenetic symptoms, which would not otherwise have been obtained."
Some provers employed peculiar proving methods, as for instance Höring who "with a hot iron burnt his arm in two places the size of a shilling, removed the epidermis and sprinkled on the raw surface 10 gr., adding a few drops of water."
Below follow two cases that provided three of the keynotes of Kali bromatum: delusion of being the object of God's vengeance, busy hands, and paranoia. The cases, treated by a Dr. Hammond, are as instructive as illustrative.
CASE 1 "A gentleman consulted me in January, 1867, for severe headache, with which he had suffered for many years. He informed me that he had once fallen from the rigging of a vessel, had struck his head, and was rendered insensible for several hours. Subsequently he had a sunstroke in Texas. I considered this a suitable case for the exhibition of the bromide of potassium, and accordingly prescribed for him a teaspoonful, three times a day, of a solution containing one ounce of the medicine to four ounces of water. He thus took about fifteen grains at a dose. The effects of this were pleasant to him, and yet not altogether so strong as he desired, that he began to increase the dose. Being absent from the city two or three weeks at that time, I did not witness the phenomena. I was informed, however, that he had exhibited symptoms of mental aberration. These wore off on the cessation of the medicine, and when I returned he was comparatively well. His headaches, however, soon returned with all their original violence, and at his earnest solicitation, and under his promise not to exceed the prescribed dose, I again gave him the bromide. He very soon began to increase the quantity, and finally seemed to have lost all control over his appetite for it. At this time I ascertained that he was in the habit of having his four-ounce vial, containing one ounce of the bromide, filled every day. The first obvious effect was an unsteadiness of gait; so great was this, that he was frequently taken for a drunken man, and on one occasion was arrested by the police, confined in a cell all night, and fined the next morning, notwithstanding my statement of the facts to the police superintendent. On another occasion I met him in the street, as I was going to visit him. He was now decidedly insane; he had delusions that lewd women had got into his mother's house; that he was pursued by the police; that his life was threatened by members of the family; that he had thousands of dollars in gold sewed up in his clothing, etc. When I met him his appearance and manner were very similar to those of a drunken man, except that his face was exceedingly pale. I may state here that this gentleman was and is a strictly total-abstinence man as regards intoxicating liquors of all kinds. His pulse which normally was about eighty, had fallen to sixty; his skin was cool and his pupils were contracted. ... His manner was excited and rambling, and his hands constantly busy, either fumbling in his pockets, tying his shoes, picking threads from his clothing, or in searching for the gold which he believed was concealed in the lining of his coat. His character had also undergone a radical change. From having been very frank and brave, he had become excessively timid, and suspicious of every trifling circumstance. Up to this period, I was not quite sure that he was suffering from the effects of bromide of potassium. His symptoms were, in many respects so much like those of an ordinary attack of acute mania, and his antecedents were of such a character, as so strongly to predispose him to an accession of the kind, that I had reason for my doubts. Nevertheless, I endeavoured to stop his use of the bromide. This was a difficult task, for notwithstanding all efforts, he continued to get hold of it. At last it was ascertained that he had secreted large quantities of it in various out-of-the-way places about the house. His mental derangement had now become so prominent and constant, that his friends became alarmed for their own and his safety. He had several times attempted to throw himself from the window, and had battered down a door with an axe, in order to escape from some imaginary danger. Under these circumstances, I recommended his committal to a lunatic asylum, and he was accordingly removed to Sanford Hall, at Flushing. Here his symptoms gradually disappeared, and in a month he returned to his home well. He has continued so to this day, with the exception that his headaches, which had disappeared while he was under the influence of the bromide, became as severe as at first, and still continue."2
CASE 2 "A very remarkable instance of the effect of large doses of the bromide of potassium over the mind exists in a case now under my care. It is that of a gentleman affected with paralysis agitans, a disease in certain forms of which I am in the habit of prescribing bromide of potassium, with a view to its sedative influence. On the 10th of October last I gave him three doses of thirty grains each. The effect was to quiet his muscular tremor, but to produce the profound melancholic delusions. He imagined that he had been specially singled out for divine vengeance, and he spent the greater part of the evening in loudly deploring his sad fate, falling suddenly asleep at intervals of a few minutes. Toward twelve o'clock he became quiet, and passed the rest of the night in a sound sleep. On the 11th he took three more doses. I saw him at six that evening; he was then walking in his room, groaning and wringing his hands. He informed me that he had been accused of robbing a friend, and that the officers were in search of him. His gait was unsteady, his hands and fingers in constant action, his face pale, and the pupils strongly contracted. While he was talking to me he said that he felt very sleepy. I persuaded him to lie down, and he was immediately sound asleep. He did not awake till five o'clock the following morning. He was then quiet, composed, and altogether in his right mind. On the 13th he took one dose of sixty grains, on his own responsibility. His tremulousness had abated from the first dose, was entirely absent on the 12th, but on the 13th feeling some slight return of it, he thought he would crush the disease at one blow. As a consequence, he was in an hour unable to stand, his face was ashly pale, his pupils contracted, and there was a loss of memory to such an extent that he forgot how to talk. For instance, when asked what made him take so large a dose, he was fully two minutes endeavouring to frame a reply, and was then obliged to give up the attempt with the remark 'I can't.' In fact, there was well-marked amnesic aphasia, for there was no difficulty in coordinating the movement of the tongue so as to articulate distinctly any word he was told to pronounce. In addition to these symptoms, there was the characteristic depression of mind, during which he experienced the most gloomy ideas relative to his present and future condition, if an opinion could be formed from the signs of distress, such as weeping, moaning, and wringing his hands, which he continued to manifest. Finally after two hours of this, he fell asleep, and when he awoke eight hours afterward, was perfectly sane. Since that time to the 20th he continued to take three doses daily, of thirty grains each, with the effect of entirely arresting the disease, and producing no other obvious effect than drowsiness, weakness of the limbs, and slight loss of memory. He is now entirely well."3
[1] Grant, Toxicology of the Eye; Springfield, Illinois, 1974. [2-3] Hale, Pathogenesis of Kali Bromatum [Bromide of Potassium]; Transaction of the New York Homoeopathic Society, 1870, nr. 8.
Affinity
MIND. NERVES [brain; spine; genitals]. Larynx. Skin.
Modalities
Worse: Mental exertion. Emotions. Periodically [night; summer; new moon]. Sexual excesses. Puberty. Hot weather. Stooping [vertigo]. Lying down [cough]. Pregnancy. Before, during and after menses.
Better: When busy.
Main symptoms
Common traits of all Kali's: conservative, regular, proper, down to earth.
In Kali-br. the main theme is a conflict between morality and immorality.
M NERVOUSNESS, depressive delusions and SUSPICION.
Fears people, yet can't be alone; looks around suspiciously.
PARANOIAC DELUSIONS.
Impression of danger; deserted, forsaken; impending destruction of all near her; being doomed; being the object of God's vengeance; life is threatened; is about to murder husband and child; cannot pass a certain place; being pursued; being pursued by police; RELIGIOUS.
• "Feel as if they would lose their minds." [Clarke]
• "These people have mood swings or tell wild, unbelievable stories which can be similar to Lachesis people. They tend to have problems maintaining intimate relationships. The active type can be very controlling and aggravating to the people around them. The passive type has incredible despair. They have feelings of hopelessness and resignation, and many are self-destructive with thoughts of suicide. The bromium element lends a sense of power to the vital force in Kali bromatum."1
M Fidgety. WRINGS HANDS.
• "HANDS and FINGERS in CONSTANT MOTION." [Allen]
• "Manner exciting and rambling; his hands constantly busy either fumbling his pockets, tying his shoes, picking threads from his clothing, or in searching for the gold which he imagined was concealed in the lining of his coat." [Allen]
• "There are two types of Kali bromatum; in my practice I see more individuals of the passive type than the active type. Both types have external and internal restlessness, but individuals of the passive types hold their restlessness in. One older patient of the passive type had the habit of firmly and rigidly pressing her hands together which prevented her from showing the characteristic restless hand gestures that are typical of this remedy."2
M Feeling of HELPLESSNESS.
M Ailments from grief and worry; loss of property or reputation; business embarrassment; fright; SEXUAL EXCESSES, masturbation [= especially restlessness, sleeplessness, brain fag, anxiety of conscience].
G Children who are not getting on well at school.
Slow, stammering speech.
Night terrors [screams, awakes terrified, recognizes no one].
Nightmare sometimes followed by squinting.
• "The mental state corresponds to the night terrors of children who start awake and then cannot be comforted. The hallucination of the child is that he is being hunted and chased by some horrible person or thing. ... This mental state, plus the overwhelming effect of the Bromium causing bronchial difficulties as croup, make this remedy particularly useful for children."3
Somnambulism.
G Puberty: strong feeling of INSECURITY [compare delusions].
Suspicion, feeling of helplessness, fears [e.g. when spoken to], and acne.
Arousal of sexual feelings; sexual fancies and masturbation, leading to a BAD CONSCIENCE [conflict with strict morality] and fear other people will perceive.
• "Looks around because he thinks people will realize these dirty thoughts are going on in his mind." [Sankaran]
G Nervous, restless women who must keep OCCUPIED.
Vomiting after / from excitement.
G Warm-blooded.
G Great thirst; craving for cold drinks.
G < 2 A.M. G Epileptic convulsions. • "In women there is a definite relationship between the periods and the onset of the fits." [Borland] Attack preceded by a sensation as if the whole body is swelling [aura]. Attack followed by severe HEADACHE. G NUMBNESS of whole body, < occiput; or local numbness. Sensation as if needles were pricking him. Benumbed feeling in brain. P Vertigo as if ground gave way; a sense of emptiness around and under his feet. • "On attempting to get up and walk, there is felt a singular vertigo, characterised chiefly by a sense of emptiness around and under feet, which he is afraid of placing wrongly; the ground seemed to be at fault and the sense of its resistance is lost, the walk is staggering and at length impossible, at least he is forced to give it up." [Hughes] P ACNE. • "Acne is by far the most frequent form of bromide of potassium eruption. According to Veiel a thickened skin, having a greasy look from the free secretion of sebaceous matter, as well as the presence of comedones or a pre-existing acne, esp. predispose to the occurrence of this eruption. ... Two varieties can be distinguished, acne punctata and acne pustulosa. Acne punctata usually preceded the pustular form. There appear red elevations, of barley-corn to pea size, on a more or less indurated base surrounded by an areola, seated by preference on the face, the eyebrows, the hairy scalp, more rarely on the breast and back, and almost never on the lower extremities. Acne pustulosa may be regarded either as the result of disintegration of the papules or as an independent form of eruption. The pustules are at first of pinhead size, of a yellowish-white colour, and surrounded by an areola. After a few days or weeks the pustule empties out its contents and a firm nodule or a red spot remains behind. ... After healing they often leave depressed, irregularly-rounded scars or spots behind." [Hughes] • "Acne simplex, indurata, rosacea, bluish red pustules on face, chest, shoulders, leaves unsightly scars; in young fleshy persons of gross habits." [Mathur] • "Acne has a very definite relation to the sexual organs, being especially noticeable at puberty and in women at the menstrual period." [Kent] • "I think the acne is always on top of a coarse skin; it is apt to be the worst acne I ever see. Possibly a Nat-m. can be as bad, but I think Kali-br. is one of the very worst of the acnes. There are no other indications. You go through their history carefully. They tell you nothing else at all, they have come about their spots. It is a pre-menstrual symptom with girls and women that before the period their acne gets absolutely terrible. They are very self-conscious about it and it worries them a lot. They are apt to feel that they are going off their heads if something cannot be done about it. If you give them Kali-br. on these few symptoms for their terrible acne, it works like a charm. It is a remedy I think of in acne when you cannot get anything out of the patient." [Blackie] [1-2] Zaren, A Case of Fatigue and Depression; HL 4/95. [3] Davis, The Kali Family; Hom. Rec., June 1939. Rubrics Mind Ailments from, business failure [1], from death of a child [2], embarrassment [1], loss of reputation [1]. Amativeness [1]. Answering, disconnected [1], in monosyllables [1], repeats the question first [1], slowly [2]. Anxiety, about health, during menopause [2]. Fruitlessly busy [1]. Complaining, during menopause [2/1]. Delusions, impression of danger from his family [1/1], of impending destruction of all near her [2/1], of being a devil [1], thought everything had been experienced before [1/1], of floating in air [1], he is insulted [1], he could not pass a certain point on walking without falling [1], of wealth [1]. Excitement, alternating with sleepiness [2]. Looking, on all sides [1/1]. Mistakes, in localities [2]. Occupation > [2]. Does not recognize his relatives [1]. Restlessness, must constantly move [2]. Suicidal disposition, throwing himself from a height [1*].
Head
Pain, alternating with asthma [1]; occiput, on shaking head [2].
Eye
Discolouration, red, during migraine [2]. Rolling movement of eyeballs [1].
Vision
Dim, from stimulants [1].
Ear
Noises, roaring, rhythmical [2].
Face
Eruptions, acne, with menstrual irregularities [1].
Mouth
Speech, stammering [2], wanting [2].
Stomach
Nausea, at thought of tobacco [1/1]. Vomiting, after excitement [1].
Female
Coition, enjoyment absent [2]. Menses, scanty, in epilepsy [2]. Pain, ovaries, from continence [1], during sexual desire [2/1]..
Chest
Palpitation, menopause [1].
Limbs
Constant motion of fingers [1]. Restlessness, hands [3].
Sleep
Falling asleep from the least mental exertion [1]. Sleeplessness, from grief [2], during menopause [2], from weakness [2].
Skin
Eruptions, urticaria, in cold air [1].
Generals
Chorea, cannot walk must run or jump [1]. Numbness, externally, whole body [3]. Trembling, externally, when something is to be done [3/1].
* Repertory addition [Hughes].
Food
Aversion: [1]: Coffee; fruit; milk; onions.
Desire: [1]: Chocolate; cold drinks [*]; wine.
Worse: [2]: Alcohol. [1]: Coffee [*; < gastric symptoms]; stimulants. Better: [1]: Cold food. * Repertory additions [Hughes].