BROMIDIA
Report of the Council on Pharmacy and Chemistry
The following report was submitted to the Council by a member of its Committee on Therapeutics, with the recommendation that publication be authorized. This recommendation was adopted.
W. A. Puckner, Secretary.
Bromidia (Battle & Co., St. Louis) at once suggests bromids; yet Bromidia is essentially a chloral rather than a bromid preparation. This nostrum illustrates the need of the provision in the Council’s Rule 8 under which recognition is refused pharmaceutical mixtures whose names do not indicate their most potent ingredients. While the chloral content of Bromidia has been given considerable publicity, yet the preparation is used both by physicians and by the public without due consideration of its potent ingredient. This fact is attested not only by the fatal results which have followed its use but also by the many reports of habit formation. As long ago as in 1887 a fatal case of poisoning was reported[5] to the medical society of the District of Columbia due to an overdose taken by a Bromidia addict. The physician who reported this case also gave his experience with another patient who had the Bromidia habit. In the discussion of the paper a number of cases were reported by others present in which Bromidia had been taken without a physician’s advice and with more or less grave symptoms of poisoning.
In the report of a death of one who had been a slave to Bromidia it was said:[6] “When the body was found, there were eleven one-ounce Bromidia bottles about the room or on his person. Nine were entirely empty and the other two were about half full. None of these bottles indicated that they had been purchased on a physician’s prescription, only the druggist’s label marked ‘Bromidia’ being on them.”
Dr. Horatio C. Wood, Jr., gave[7] a striking illustration of how preparations like Bromidia come to be used even by physicians without consideration of their constituents:
“Within an hour after his father, a Brooklyn physician, had given him a dose of bromid, H.G.P., a prodigal son, died yesterday at his father’s home in Brooklyn. Two years ago, when he appeared to have sown his wild oats, the father made him superintendent of his country place, near Grants Mills, Delaware County. A week ago the son left his place, and at 1 o’clock yesterday morning appeared at his father’s Brooklyn home. He was nervous, and at 9 a. m. begged for a sedative.
“‘I prescribed the usual quantity of bromidia,’ the young man’s father told a reporter. ‘He was weak and had suffered from weak heart and kidney trouble for some time.’
“An hour later the father found the son dying and administered restoratives, but to no avail.”
A circular, “The Advantages of Bromidia,” makes it plain how physicians come to use a preparation like Bromidia without consideration of its potent constituent. In this circular the presence of chloral is at first frankly admitted, then it is suggested that in the combination the evil effects of chloral are completely eliminated and in the end the impression is left that Bromidia is practically innocuous. Thus at the beginning while arguing that Bromidia is better than extemporaneous preparations the chloral content is plainly acknowledged:
“In the untoward effects so frequently attending the use of extemporaneously prepared mixtures of chloral and the bromides, may be found the reason for BROMIDIA’S preference when the need for a hypnotic agent arises. Were it not for the well known disadvantages of these drugs which become still more marked with their continued use, there could be no special need for such a preparation as BROMIDIA (Battle), for the therapeutic powers of chloral and the bromides are among the most positive facts in medicine.”
Again:
“It was to meet the growing professional demand for a combination of chloral and the bromides with their evil effects eliminated, that led to the manufacture of BROMIDIA (Battle).”
Then, suggesting the indiscriminate use of Bromidia—as an entity as Dr. Wood suggests—the claim is made that:
“... its constituents have been chosen with a view of enabling Bromidia to meet every requirement for an agent of its class.”
“Owing to the exceptional purity of its component parts and its freedom from untoward effects when continued over long periods, this product will be found of the highest utility in epilepsy.”
“... its action is that of chloral and the bromides minus their evil effects.”
Finally Bromidia becomes a simple bromid preparation. Thus an advertisement reads:
“Bromidia’s (Battle) Marked Sedative and Antispasmodic Qualities eminently fit it for the treatment of Maniacal Excitement, Epilepsy, Spasmodic Asthma, Convulsive Seizures of Reflex Origin, Sexual Neuroses, and other disorders attendant upon nervous irritability.
“Through its exhibition, the fullest therapeutic power of the bromides may be secured with a minimum of their evil effects; a feature of the greatest service when the necessity for continued treatment becomes necessary.”
In addition to the general invitation to use Bromidia in epilepsy and various nervous disorders, a circular also recommends its use in typhoid, a recommendation, which, if followed, may turn the scale in favor of a fatal result. The circular states:
“As a soothing agent in the extreme restlessness and irritability of typhoid fever and other infectious diseases, BROMIDIA (Battle) is a therapeutic weapon of definite service. Relief of the headache of typhoid may also be secured through the use of BROMIDIA (Battle). By means of its administration for the above purposes, the patient’s strength is conserved and as a result he is much better prepared to stand the force of the infection.”
Particularly vicious is the recommendation that it be given to children. Thus, in a pamphlet entitled “Effective Drugs Effectively Combined”:
“Another point of advantage to be found in bromidia is the ease with which it is borne by children. Owing to this tolerance, it is of distinct service in a considerable list of disorders of childhood. Thus, of course, employed with care and an understanding of its potency, bromidia has a field of usefulness in chorea, laryngismus stridulus, and whooping-cough. In other nervous disorders of childhood—those attending acute infections, for instance—bromidia is a definitely indicated therapeutic aid, owing to the soothing influence exerted by even a moderate dose and the absence of untoward effects. More specifically, the correcting influence of bromidia in the night-terrors of children may be mentioned.”
Formerly advertisements asserted that each fluidram of Bromidia contained:
| “Chloral hydrate | 15 | grains |
| “Potassium bromid | 15 | grains |
| “Extract of Cannabis indica | 1⁄8 | grain |
| “Extract of henbane | 1⁄8 | grain” |
This formula also appears on the label of a sample package sent through the mails during 1914. A recent circular contains a somewhat different formula. Instead of “1⁄8 gr. each of gen. Imp. Ext. Cannabis Ind. and Hyoscyam.” as was formerly claimed, each fluidram of Bromidia is now said, not to “contain” but to “represent,” not the extracts but the far less potent drugs “Cannabis indica 1⁄8 grain, Hyoscyamus 1⁄8 grain,” thus:
| “Chloral hydrate | 15 | grains |
| “Pot. brom. | 15 | grains |
| “Cannabis indica | 1⁄8 | grain |
| “Hyoscyamus | 1⁄8 | grain” |
Furnishing still greater variety, the labels on a recently purchased bottle of Bromidia, where under the Food and Drugs Act the presence of narcotic drugs must be declared, read:
“Alcohol 10 per cent., Chloral Hydrate, 91 grs. per ounce. Cannabis indica indeterminate in finished product.”
“In the manufacture of BROMIDIA to each drachm of fluid used are added 15 grains of pure chloral hydrate and purified brom. pot., and 1⁄8 grain each of gen. imp. ext. cannabis ind. and hyosciam.”
These various statements as to the composition of Bromidia leave one very much “in the air.” As chloral and potassium bromid are easily determined and since lying on the labels of widely exploited proprietaries has become somewhat risky recently, it is probable that the statements on the trade package are to be depended on and that each fluidram of Bromidia contains something like 12 grains each of chloral and potassium bromid and not 15 grains as the medical profession has been and is being told.
Pharmacists who have attempted to put up a nonproprietary preparation similar to or, more correctly, having the alleged composition of Bromidia have found it practically impossible to do so. The reason is that extract of cannabis indica is almost insoluble in a menstruum such as that found in Bromidia. The National Formulary, first edition, listed Mistura Chlorali et Potassii Bromidi Composita of which it was said: “Each fluidram contains 15 grains each of Chloral and of Bromid of Potassium, and 1⁄8 grain each of Extract of Indian Cannabis and Extract of Hyoscyamus.” In this the pharmacists attempted to incorporate the cannabis indica by using the tincture of the drug and suspending it by the addition of tincture of soap bark. In the present edition of the National Formulary, the preparation is made by triturating the extract of cannabis indica with pumice stone and then filtering the finished product. This gives an “elegant” preparation—but one from which the cannabis indica is filtered out! A sad commentary on the National Formulary. It should not be supposed, however, that the manufacturers of Bromidia have solved the problem that has baffled the pharmacists; not at all. Bromidia probably contains no more cannabis indica than does its National Formulary prototype. The statement on the present trade packages, that the amount of cannabis indica in Bromidia is “indeterminate,” is but a tardy acknowledgment of the fact that the stuff has not, and never had, the amount of cannabis indica claimed for it for so many years.
The “indications” named on the Bromidia labels are, in common with nostrums of this type, but suggestions for self-drugging. They will appeal to the layman who has purchased, either by prescription or otherwise, an “original package” of Bromidia and who may imagine he suffers from “nervousness,” “sleeplessness,” “headache” or “neuralgia.”
But while the manufacturers in their advertising matter have on the whole not disguised the presence of chloral so much as they have attempted to make it appear that the chloral has been robbed of its dangers—for all hypnotics if used thoughtlessly are dangerous—after all the name has created the false impression that Bromidia is a bromid preparation. It is because of this false impression carried by its name, that Bromidia came to be used indiscriminately by the profession and in the course of time still more indiscriminately and recklessly by the public. Bromidia is a vicious chloral preparation masquerading under a misleading name. That physicians have been impressed by the claims of its harmlessness and by the mystery connected with the formula is not a credit to the intelligence of our profession. There is no doubt but that physicians are responsible for the use and abuse of this chloral preparation by the public.
There is no scientific or rational excuse for a ready-made preparation of this sort. When chloral or a bromid is indicated the proper dose of each of these, if they are to be combined, should be determined for each patient. Potassium bromid and chloral hydrate both are readily soluble in water, syrup or elixirs and it is a simple matter to prescribe the required dose of chloral and of bromid dissolved in some aromatic water like cinnamon-water (Aqua Cinnamomi), in some syrup like syrup of orange (Syrupus Aurantii) or in an elixir like the aromatic elixir (Elixir Aromaticum) or adjuvant elixir (Elixir Adjuvans). If this mixture is prescribed thus the physician is alive, alike to the dangers and the limitations of the drugs; if it is prescribed under a misleading proprietary name, the physician endangers his patient, stultifies his profession and tends to perpetuate the great American fraud.
[Editor’s Note.—A list of some of the medical journals that advertise Bromidia:
| Texas Medical News | Southern Practitioner |
| Nashville Journal of Medicine & Surgery | New Orleans Medical & Surgical Journal |
| Medical Brief | Therapeutic Gazette |
| Annals of Surgery | Medical Herald |
| Charlotte Medical Journal | Medical Times |
| Medical Sentinel | Texas Medical Journal |
| Memphis Medical Monthly | Wisconsin Medical Recorder |
| Laryngoscope | International Journal of Surgery |
| Medical World | Vermont Medical Monthly |
| Medical Review of Reviews | Atlanta Journal-Record of Medicine |
| Louisville Monthly Journal | St. Paul Medical Journal |
| Indianapolis Medical Journal | Hospital Bulletin of the University of Maryland |
| Monthly Cyclopedia & Medical Bulletin | Denver Medical Times |
| Journal of Nervous & Mental Diseases | Buffalo Medical Journal |
| Maryland Medical Journal | Medical Review |
| Merck’s Archives | Ellingwood’s Therapeutist |
| Iowa Medical Journal | Eclectic Medical Journal |
| Medical Standard | Massachusetts Medical Journal] |
| —(From The Journal A. M. A., May 16, 1914.) |