Vol. CIV., No. 22.] 
BOSTON/MEDICAL AND) SURGICAL JOURNAL. 
blood pressure fell from the first, and continued to sink 
until it reached zero. In animals with cut vagi nerves, 
doses which would cause a primary fall of pressure in 
normal animals would induce a rise, and it was also 
noticeable that the rise of pressure, as a rule, was 
more marked in animals thus operated upon. This 
clearly indicates that the drug exerts some action on 
the pressure through the vagi nerves. After isolation 
of the heart from any centric nervous influence by 
severing the vagi nerves and cervical portion of the 
spinal cord, essentially the same results followed as 
occurred in normal animals. This, therefore, shows 
that outside of the action on the vagi nerves, as just 
referred to, these changes in the arterial tension must 
be dependent upon the action of the acid on either or 
both the heart and vaso-motor peripheries. In order 
to determine if the drug had any effect on the latter, 
microscopical examinations of the web of the frog’s 
foot were made, and it was found that the local appli- 
cation of the diluted acid caused a distinct capillary 
contraction. A marked pallor was noticed after the 
local application of the acid to muscular tissue, but 
just how far this was due to capillary contraction or to 
probable myosic coagulation is unknown ; the same pal- 
lor was also noticeable in some instances about the lips 
and eyes of animals under the influence of toxic doses. 
I think, therefore, from the above results, that it is 
fair to conclude that the peripheral vaso-motor mech- 
anism is stimulated. 
When the drug is applied locally to the heart the 
cardiac power becomes at once diminished, and the 
pulsations are soon arrested. 
It is evident from the above results that the rise of 
pressure was due to a stimulation of the peripheral 
vaso-motor mechanism, and the fall to a direct depress- 
ant action on the heart muscle. The reason why a 
rise of pressure occurred during a consentaneous de- 
pression of the cardiac power was probably and simply 
because of a comparatively more intense action on the 
vaso-motor peripheries, the diminished capillary lumen 
being sufficient to more than compensate for the dimin- 
ished power of the heart. 
The pulse-rate was not appreciably affected by very 
small doses. Larger doses sometimes caused a mo- 
mentary slowing, with a diminution of the arterial 
pressure (making a tracing similar to that caused by 
inhibiting the heart), and after the subsidence of this 
inhibition the pulse, to a various extent, recovered, not, 
however, reaching the normal, and it then became 
slowly diminished; at other times a momentary rise 
occurred (accompanied by a consentaneous diminution 
of the arterial pressure, but differing in character from 
that above noted) which equaled about one tenth to 
one fifth of the normal in excess, and this rise was fol- 
lowed by a diminution equaling about one third to 
one half of the normal. The increase of the pulse- 
rate was marked by pulse-curves, which were lower 
and less abrupt in their line of ascent than those of 
the normal, and the diminished pulse-rate by curves 
which were higher and more abrupt in ascent. After 
large and repeated doses (thirty drops in dogs) the 
pulse-rate fell below, but remained near, the normal 
until after the second, third, or fourth doses, and it 
then either rapidly fell to zero, or rose very rapidly 
(in one instance from thirty-three to seventy-eight 
pulsations in forty seconds) ; or, in a third lot of cases 
it rose gradually to the normal (taking in one instance 
six minutes to do so), and sometimes continued to in- 
Original SlrticI^C 
IIYDROBROMIC ACID: ITS ACTIOt 
CIRCULATORY AND /NERYOUSS^FSlT^MS. 
BY EDWARD T. REICHERT, M. D., NEWARK, N. J. 
Late Demonstrator of Experimental Therapeutics and Instructor in Exper- 
imental Physiology in Post-Graduate Course in Medicine, University of 
Pennsylvania. 
The several papers which have been recorded on 
the therapeutical use of hydrobromic acid indicate that 
this new drug possesses sufficient promise to call for a 
close study of its physiological properties, and espe- 
cially so because of the asserted similarity of its physi- 
ological action and that of the alkaline bromides, to- 
gether with the noticeable absence of the disagreeable 
digestive derangements which are known to so often 
follow the extended use of the alkaline salts. In a re- 
view of these papers it is found that this agent was 
first employed by Wade, who states that it fully rep- 
resents the action of bromine on the system, and that 
it modifies the action of both quinine and morphia on 
the brain, the same as the potassium bromide. These 
statements have been corroborated by other observers, 
some of whom have further claimed that its effects are 
more intense, but less permanent, that it lacks the ac- 
tion of the potassium bromide on the heart and muscu- 
lar systems, that it has been used with marked success 
in the treatment of tinnitus aurium, supposed to be 
due to labyrinthine congestion, that it is a tonic to the 
digestive organs, and that it readily becomes decom- 
posed in the stomach.1 
This is the sum of the knowledge we possess of the 
action of this acid on the economy, and it certainly is 
sufficient to indicate, if the above statements be true, 
that we have a valuable addition to our materia medica. 
In order, however, to conclusively determine whether 
the acid possesses the peculiar physiological properties 
of the alkaline bromides, the following investigation 
was made, and since the recognized therapeutical prop- 
erties of the alkaline salts are conceded to depend 
upon their peculiar actions on the circulatory and 
nervous systems, my researches were confined to this 
special study. One difficulty, however, to contend 
with in a comparison of the actions of this acid and 
alkaline bromides is that no thorough manometrical 
study of the action of the latter has yet been made, 
and even the papers so far published present conclu- 
sions which are at variance on many points. 
In my experiments on the circulation it was found 
that the arterial pressure was affected in one of three 
ways, evidently depending upon the dose given. Thus, 
after very small doses it was wholly unaffected or a 
slight rise, which was almost inappreciable, occurred. 
After larger doses the pressure generally fell a little 
(making a tracing similar to that produced by stimu- 
lating the cardiac inhibitory nerves), and was followed 
by a return to or above the normal, and if the arterial 
tension was increased above the normal, it frequently 
remained so for six, eight, or ten minutes. In exper- 
iments when the pressure did not primarily fall, it in- 
creased from the first, and usually equaled, when it 
reached its greatest height, about one sixth of the nor- 
mal pressure. After very large or toxic doses, the 
1 Wade (Peninsula Journal of Medicine, February, 1875, p. 62); 
Fothergill (British Medical Journal, 1876, i. p 42); Forrest (ibid., 
1877, p. 398); Campbell (ibid., p. 480); Fry (ibid., p. 480); Woakes 
(ibid., p. 773); Hamilton (Philadelphia Medical Times, 1877, p. 31); 
H. C. Woods (Therapeutics, 1879, p. 333); Browne (British Medical 
Journal, 1877, ii. p. 13). 506 
BOSTON MEDICAL AND SURGICAL JOURNAL. 
[June 2, 1881. 
crease considerably. If the doses are still repeated in 
cases like the last two the pulse-rate may rise at every 
dose, being followed by a diminution, and finally, a 
last dose will cause it to rise to a considerable height, 
near which point it may remain a few seconds, when 
the heart fails and the pulsations become slowed and 
gradually diminish until death ensues; or, instead of 
the final injection causing such a very marked rise, it 
may so affect the heart that its movements are at once 
arrested. In these several instances the increased 
pulse-rate was always accompanied by a diminution of 
the blood pressure, deep and labored respirations, and 
often struggles, and the pulse-curves were equal to 
only about from one tenth to one eighth of the normal 
size. 
After section of the pneumogastric nerves, no change 
from the above results occurred, except that the very 
transient inhibition of the heart immediately following 
an intravenous injection was not present. The same 
may also be said of the results of experiments made on 
animals with cut cervical spinal cords and pneumogas- 
tric nerves, by which the heart was cut off from im- 
pulses originating in or reflected from the nervous cen- 
tres. It is obvious, then, that with the exception just 
made, the changes in the pulse produced by hydrobro- 
mic acid are due to a direct action on the heart, and 
that this action is one of paralysis is evident from the 
fact that the increased pulse-rate was accompanied by 
a diminished size of the pulse-curves and diminished ar- 
terial pressure (notwithstanding an attendant condition 
of capillary constriction). It is obvious, then, that the 
increased pulse-rate was not an evidence of cardiac 
stimulation, but of depression, and was no doubt, in a 
measure, but a compensating action of the heart in en- 
deavoring to overcome by increased frequency of pul- 
sation, the results of its diminished power. It has been 
further found that the heart is less irritable after death 
than normally, and that the exposed heart of the frog 
was paralyzed by a direct application of the diluted 
acid. 
Upon the nervous system hydrobromic acid seems to 
act as a universal depressant, producing in frogs, in 
toxic doses, a diminution and final extinction of all re- 
flex and volitional phenomena, and the early induction 
of narcotism. In dogs, cats, and rabbits the action on 
the brain is comparatively feeble, while the same is 
equally as true as regards the action on reflex and vol- 
untary movements, although not so marked. In frogs 
reflex activity is slowly and gradually diminished until 
a certain period is reached, varying from seven to 
twenty minutes, when it suddenly and completely dis- 
appears, at which time neither mechanical stimuli, nor 
the strongest current obtained from a Leclanche cell 
and a Du Bois Reymond induction coil would induce 
the least response. It was also noticeable that failure 
of reflex movements occurred first in the posterior ex- 
tremities, and that after stimulus, when applied to them, 
would elicit no reflex response whatever, response would 
still be called-forth by stimulus applied to the anterior 
extremities ; and in several instances, not only were 
these movements present in the anterior extremities 
when they were stimulated, but also in the posterior, in- 
dicating that the cause of failure of reflex movements in 
the posterior extremities when stimulus was applied to 
them was on account of a paresis of either the sensory 
nerves or sensory portions of the cord. For the motor 
nerves and motor portions of the cord must be capable 
of transmitting impulses else reflex phenomena would 
not have occurred in the posterior extremities in those 
cases where the anterior extremities alone were irri- 
tated. On account of the interest centred in these 
experiments, the results of one of them is given in de- 
tail : — 
Experiment. Frog; normal. 1.53 p. M. Reflex ac- 
tion occurred in one and a half seconds after immersion 
of posterior extremities in a two-per-cent, solution of 
sulphuric acid; the frog’s legs were then completely 
washed of the acid solution by a gentle stream of water. 
1.55. Ten minims of hydrobromic acid, properly di- 
luted, were injected into the posterior lymph-sac. 2.00. 
Reflex action, tested as above, occurred in two seconds, 
the frog’s legs being washed as before. 2.05. No re- 
flex movements occurred even after a minute’s immer- 
sion of the posterior extremities ; reflex movements oc- 
curred in the anterior extremities in three seconds after 
being dipped in the acidulated solution, and were ac- 
companied by feeble reflex movements in the poste- 
rior extremities. 
Although in my experiments with this acid volun- 
tary movements were never observed to occur after 
the suppression of reflex activity, such as have been 
so frequently observed after poisoning with the alka- 
line bromides, yet the above result certainly indicates 
that the action of these two poisons on both reflex and 
voluntary movements is identical ; and this has been 
found by further experimentation to be the case, for in 
animals in which the abdominal aortas were ligated 
for the purpose of preventing the access of poison to 
the posterior extremities, reflex movements failed in 
the unpoisoned limbs as soon as they did in the others, 
indicating that the failure of these movements must 
have been due to a direct action of the acid on the 
spinal cord. Farther, by applying a galvanic current 
to the exposed spinal cord in the dorsal region of pois- 
oned animals, no movements occurred in the anterior 
extremities, but pronounced movements were induced 
in the posterior; certainly showing that the inability 
of the cord to convey impulses upward must have been 
due to a paralysis of its sensory portions, while the 
motor portions must still have been intact, as was evi- 
dent by the contractions caused in the posterior ex- 
tremities. It is obvious from this that the seat of re- 
flex paralysis lies in the sensory (reception) portions 
of the cord, and that if the motor portions of the cord 
and motor nerves still remain sufficiently intact to con- 
vey impulses, after complete paralysis of the sensory 
portions of the cord, the possibility of the occurrence 
of voluntary movements, or at least of movements the 
impulses of which have their origin in the cerebral 
ganglia, is readily conceivable. And it is probable 
that with small doses such phenomena will occasion- 
ally occur. Whether the peripheries of the sensory 
nerves are affected or not early in the poisoning I have 
been unable to decide, on account of the early depress- 
ion of the sensory portions of the cord ; I, however, do 
not think they are, because in animals in which all the 
blood-vessels of the left leg were ligated it was found 
that the unpoisoned nerve failed to respond to stimulus 
just as soon as the oilier; but that they are ultimately 
affected seems proven by the fact that the local action 
of the dilute acid rapidly destroys their activity. The 
motor portions of the cord as well as the motor nerves 
are also depressed, as determined by definite strengths 
of electric currents, and are ultimately paralyzed— the 
former succumbing first; since the motor nerves will 
still transmit impulses even after a complete abolition Vol. CIV., No. 22.] 
BOSTON MEDICAL AND SURGICAL JOURNAL. 
507 
of the functional activity of the motor portions of the 
cord. Consciousness in the higher vertebrates was 
maintained until almost death ensued, although in frogs 
narcotism seemed early induced. 
In the early part of this paper it was stated that it 
was claimed that the acid “ possesses all the more val- 
uable properties of the potassium bromide, but lacks 
its influence on the heart and muscular systems ; ” but 
whatever it may possess of the aforesaid valuable prop- 
erties, it certainly does affect the heart the same as the 
potassium bromide, as has already been conclusively 
proven; it depresses the skeletal muscles and ultimately 
paralyzes them (as I have also satisfactorily decided, 
although it is here unnecessary to give the detailed re- 
sults of this research), and acts on the nervous system 
markedly similar. 
A summary of the conclusions drawn from the re- 
sults of the present research is placed for the conven- 
ience of reference in a parallel column with the con- 
clusions arrived at by the different investigators on 
the action of the potassium bromide, which represents 
the physiological action of the alkaline salts. 
are the first portions of the re- 
flex apparatus to be paralyzed, 
and reflex paralysis is due to 
this cause. The motor portions 
of the cord are also depressed, 
as well as both the sensory and 
motor nerves. 
Muscular System. The mus- 
cular system is depressed. 
the lower animals, but that the 
cerebrum, the motor tract of 
the cord, and the efferent nerves 
are the last portions to be af- 
fected ; that the most sensitive 
is the receptive [sensory] por- 
tion of the cord . . . and next 
to this are the peripheral ends 
of the sensory nerves.” (II. C. 
Woods’ Therapeutics, 1879, p. 
825). 
Muscular System. Depressed, 
(Papers Quoted.) 
A MEMBRANE-LIKE AFFECTION OF THE BOW- 
BY FRANCIS W. GOSS, M. D. 
ELS.1 
By the above title I refer to a disease which has 
been designated by a variety of names, among them, 
“ Painful Affection of the Intestinal Canal,” by Powell,2 
“ Diarrhoea Tubularis,” by Good,8 “ Mucus Disease ” 
by Whitehead,4 and “Membranous Enteritis” by Da 
Costa.6 The affection, though not remarkably uncom- 
mon, is not often described by medical writers or re- 
ferred to in text-books. It is characterized by the dis- 
charge from the bowels of what appear to be mem- 
branes or skins, of varying size, in the form of shreds, 
strips, or tubes. This peculiar discharge is accompanied 
with uneasiness and discomfort, if not with actual pain. 
The malady is of long duration, the patients, during 
the period of weeks or months while suffering from 
the discharge, being invalids, often confined to the bed 
or house. They seldom so far recover as to be in 
robust health, and sooner or later are subjected to re- 
currences of the trouble with the accompanying physi- 
cal weakness and suffering. 
Powell, in 1818, appears to have been among the 
first of modern writers to have called attention to the 
disease. He describes the evacuations of his patients 
suffering from the affection to have “ exhibited a large 
quantity of flakes mostly torn into irregular shapes, 
and appearing to have formed parts of an extensive 
adventitious membrane of no great tenacity or firm- 
ness.” “ In the first of the cases which came under 
my notice,” he says, “ this membrane was passed in 
perfect tubes, some of them full half a yard in length, 
and certainly sufficient to have lined the whole intes- 
tinal canal. In others, also, the aggregate quantity 
has been very large, and it has continued to come 
away for many days, but it has been in irregular, thin 
flakes of not more than two inches in extent.” And 
he further adds, “ The appearance which comes nearest 
to it, both in resemblance and situation, is the mem- 
brane formed in the trachea under croup.” Powell 
observed four cases, all in adult females. 
HYDROBROMIC ACID. 
The Circulation: Arterial 
Pressure. The arterial pres- 
sure is unaffected by very small 
doses, or a slight rise occurs; 
moderate doses cause an in- 
crease from the first, or a dim- 
inution of pressure, followed 
by a return to or above the 
normal; large doses cause the 
pressure to fall, and if suffi- 
cient cause it to fall to zero. 
The fall of pressure is due to 
a depression of the heart mus- 
cle. 
The rise of pressure to a con- 
striction of the vaso-motor per- 
ipheries. 
POTASSIDM BROMIDE. 
Arterial Pressure: Adminis- 
tered hypodermically it causes 
diminished arterial tension, 
with increased pulse frequency. 
Large doses paralyze the heart, 
and thus reduce arterial pres- 
sure (I. G. Schonten, Archiv 
der Heilkunde, xii., 2, 1871 ; 
Schmidt’s Jahr., Bd. c. liv.). 
(See above.) 
Vaso-motor peripheries ir- 
ritated, causing constriction 
(Lewisky, Virchow’s Archiv, 
Bd. xlv., p. 191; Amory, The 
Phys. and Ther. Action of Bro- 
mide of Potassium, Boston, 
1872; Meuriot, L’etude de la 
Belladone, p. 49; Saisson, 
Schmidt’s Jahr., Bd. cxliii.) 
This action on the capillaries 
has been denied. 
Pulse. After slow intraven- 
ous injection of a two per cent, 
solution of the potassium bro- 
mide, the pulsations become 
slower and feebler, the blood 
pressure falls, and the heart is 
finally arrested. Hypodermical- 
ly injected, the pulse-rate is in- 
creased with diminished arte- 
rial pressure and diminished 
pulse-curves. Large doses par- 
alyze the heart (Schonten, loc. 
cit.; Eulenberg and Guttman, 
Virchow’s Archiv, xli., 1867). 
Pulse. The pulse-rate is not 
appreciably affected by very 
small doses; moderate doses 
sometimes caused a momentary 
slowing by inhibiting the heart, 
the pulse then recovering to a 
variable extent, and being fol- 
lowed by a gradual fall; or, a 
momentary rise occurs accom- 
panied by a diminution of ar- 
terial pressure, this being fol- 
lowed by a diminution to below 
the normal; or, after large and 
repeated doses the pulse falls 
below normal and then becomes 
exceedingly rapid, or becomes 
rapid from the first, or may be 
depressed from the first. All 
these effects being due to a di- 
rect cardiac action, with the 
above single exception. The 
increased pulse-rate being at- 
tended with a diminution of 
pressure and small pulse- 
curves. 
Nervous System: Cerebrum. 
Consciousness in the higher 
mammals present until near 
death. Spinal Cord. The sen- 
sory portions of the spinal cord 
I have myself notes of the following cases, the first 
two of which have been under my observation a por- 
tion of the period of their sickness. They both oc- 
curred in ladies of more than ordinary intelligence, 
able to give an accurate account of their ailments. 
1 Bead before the Boston Society for Medical Improvement, May 
23,1881. 
2 On Certain Painful Affections of the Intestinal Canal. Transac- 
tions of College of Physicians, London, vol. vi. 
3 Good’s Study of Medicine, vol. i. Diarrhcea Tubularis. Tubu- 
lar Looseness. 
4 Notes on Mucus Disease. By Walter Whitehead, F. R. C. S. 
Edin. The Manchester Medical and Surgical Reports, 1870, vol. i. 
6 Membranous Enteritis. By J. M. Da Costa, M. D. The Amer- 
ican Journal of the Medical Sciences. October, 1871. 
Cerebrum, Spinal Cord and 
Nerves. “ The evidence is, I 
think, sufficient to prove that 
bromide potassium affects all 
parts of the nervous system of