Practical notes on diagnosis, prognosis, and treatment in cases of delirium tremens / by Thomas Laycock.

  • Laycock, Thomas, 1812-1876.
Date:
1862
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Licence: Public Domain Mark

Credit: Practical notes on diagnosis, prognosis, and treatment in cases of delirium tremens / by Thomas Laycock. 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.

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    Infirmary, if it had been raet in those days by beuig left to nature, or by a treatmenl in the main expectant, such as we employ at present.—Clinical Medicine, p. 262. While conceding that the habits of the Scottish people may have improved of Lite yeai's, and tliat there are consequently fewer cases of delirium tremens to treat (although even this is doubtful,) I must venture to question altogether the alleged fact of change of type, and of diminishing severity, in those which do occur. I have seen cases of delirium tremens for more than thirty years, and I can state that nothing I have observed during that period would allow me to draw such a conclusion. I see no such difference in the intensity of the cases, understanding by that term a violent and intractable character of the symptoms and a tendency to death. If I stood alone in the numerical conclusions I draw as to the com- parative results of treatment, I should certainly feel inclined to suspect a fallacy somewhere ; but Dr Ware of Boston, who published the results of his treatment in the Boston Medical and Surgical Journal for 1838, investigated the whole subject very carefully. The cases which he treated in private practice, in all 69, occurred during a period of about 20 years, thus carrying the date of his observations back to 1818. Other 31 cases were treated in the Almshouse. Various methods of treatment were adopted, and notes taken of the complications. I subjoin a table of his remedies and the results. Treatment by Dr Ware of Cases of Delirium Tremens. No.ofCases. Bled. Died. Recovered. Complicated with Acute Diseases. Opium, large doses, 8 0 4 4 1 Do. small doses, . . 7 1 2 5 1 12 1 1 11 2 Bleeding (only), . . . 2 2 0 2 0 9 5 3 6 7 Mercurials, .... 1 0 0 1 1 1 0 0 1 0 29 4 1 28 1 Total, 69 13 11 58 13 It appears from this table that of 15 cases treated by opium 6 died, or at the rate of 40 per cent, (the Edinburgh mortality of 1843-44), while of 54 treated by emetics, etc., but without opium, only 5 died, or at the rate of 9^ per cent. If, however, we compare the mortality when the treatment was by opium in large doses, with that of the expectant method specially, we find that of the former 50 per cent., or one-half died, of tlie latter only 3*44 per cent., or 1 in 29. In each group there was one case complicated with acute disease, which, if eliminated as a fatal case in each, Avhatever the treatment, leaves 3 deaths in 7 treated by large doses of opium, and no deatli in 28 treated on the expectant plan. All these were treated more